Routinely measuring and reporting pneumococcal vaccination among immunosuppressed rheumatology outpatients: the first step in improving quality.
OBJECTIVE
The Centers for Disease Control (CDC) recommends pneumococcal vaccination for immunocompromised patients. Data suggest that rates of vaccination in this population are not optimal. To support continuous quality improvement efforts, we electronically measured vaccination status among rheumatology outpatients over time.


METHODS
Using data from administrative (billing) and electronic health record sources, we identified rheumatology clinic patients seen between 1 February 2008 and 31 January 2010 and prescribed an immunosuppressive medication. CDC recommendations for pneumococcal vaccination were applied. We calculated the proportion of eligible patients who were up-to-date with pneumococcal vaccination: (i) while on an immunosuppressive medication and (ii) before newly starting an immunosuppressive medication in the last 12 months.


RESULTS
We identified 2763 rheumatology clinic patients on immunosuppressive medications, with 568 initiated in the last 12 months. The mean age was 57 years, 75% were female and 77% were Caucasian. The most frequent disease was RA (50%) and the most common immunosuppressive medication was MTX (59%). Of patients on immunosuppressive medications, 1491/2763 (54%) were up to date with pneumococcal vaccination. Among new initiators of immunosuppressive medications, 258/568 (45%) were vaccinated before starting the immunosuppressive medication. Patients treated by rheumatologists in practice for ≤10 years were more likely to be up to date with pneumococcal vaccination (72%) than those with providers in practice >10 years (52%, P < 0.001).


CONCLUSIONS
The proportion of patients who are up to date with documented pneumococcal vaccination was suboptimal in our rheumatology practice. The ability to continuously repeat electronic measurement permits us to initiate continuous quality improvement efforts.
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. sdesai5@partners.org
Sonali P
SP
Desai
Alexander
A
Turchin
Lara E
LE
Szent-Gyorgyi
Michael
M
Weinblatt
Jonathan
J
Coblyn
Daniel H
DH
Solomon
Allen
A
Kachalia
D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000276:immunology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology / Q000627:therapeutic use*; D011787:Quality of Health Care; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D014481:United States
D007166:Immunosuppressive Agents; D022242:Pneumococcal Vaccines