title: Re-engineering the primary care practice to eliminate adult immunization disparities.
abstract: Traditional "one-patient-at-a-time," doctor-centered primary care practice models do not achieve optimal immunization rates for pneumonia and influenza, in part because of time pressures and competing demands from a burgeoning list of clinical guidelines. Some widely used quality improvement methods (physician education, provider feedback, academic detailing, etc.) have only a modest and short-lived impact on improving immunization rates. Evidence is mounting that practices can substantially improve immunization rates by changing practice systems and processes with standing orders and algorithms, expanded nurse decision-making, patient education and incentives, and partnerships with community-based pharmacies. Quality-focused, constantly-learning practices that cultivate a culture of excellence will be most effective in adopting such changes.
authors.affiliation: National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA. grust@msm.edu
authors.forename: George
authors.initials: G
authors.lastname: Rust
authors.forename: Harry S
authors.initials: HS
authors.lastname: Strothers
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000555:Ambulatory Care Information Systems; D019317:Evidence-Based Medicine; D006297:Health Services Accessibility; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000600:supply & distribution; D007251:Influenza, Human / Q000517:prevention & control; D009936:Organizational Innovation; D010594:Pharmacies / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D007252:Influenza Vaccines