Using information technology to improve adult immunization delivery in an integrated urban health system.
BACKGROUND
Adult immunizations prevent morbidity and mortality yet coverage remains suboptimal, in part due to missed opportunities. Clinical decision support systems (CDSSs) can improve immunization rates when integrated into routine work flow, implemented wherever care is delivered, and used by staff who can act on the recommendation.


METHODS
An adult immunization improvement project was undertaken in a large integrated, safety-net health care system. A CDSS was developed to query patient records and identify patients eligible for pneumococcal, influenza, or tetanus immunization and then generate a statement that recommends immunization or indicates a previous refusal. A new agency policy authorized medical assistants and nurses in clinics, and nurses in the hospital, to use the CDSS as a standing order. Immunization delivery work flow was standardized, and staff received feedback on immunization rates.


RESULTS
The CDSS identified more patients than a typical paper standing order and can be easily modified to incorporate changes in vaccine indications. The intervention led to a 10% improvement in immunization rates in adults 65 years of age or older and in younger adults with diabetes or chronic obstructive pulmonary disease. Overall, the improvements were sustained beyond the project period. The CDSS was expanded to encompass additional vaccines.


CONCLUSIONS
Interdepartmental collaboration was critical to identify needs, challenges, and solutions. Implementing the standing order policy in clinics and the hospital usually allowed immunizations to be taken out of the hands of clinicians. As an on-demand tool, CDSS must be used at each patient encounter to avoid missed opportunities. Staff retraining accompanied by ongoing assessment of immunization rates, work flow, and missed opportunities to immunize patients are critical to sustain and enhance improvements.
Health TeamWorks, Lakewood, Colorado, USA. cswenson@healthteamworks.org
Carolyn J
CJ
Swenson
Alicia
A
Appel
Moira
M
Sheehan
Anne
A
Hammer
Zita
Z
Fenner
Stephanie
S
Phibbs
Marjie
M
Harbrecht
Deborah S
DS
Main
D000368:Aged; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007252:Influenza Vaccines / Q000008:administration & dosage; D007256:Information Systems / Q000458:organization & administration*; D007318:Inservice Training / Q000458:organization & administration; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D058996:Quality Improvement / Q000458:organization & administration*; D013745:Tetanus Toxoid / Q000008:administration & dosage; D019037:Urban Health Services / Q000458:organization & administration*
D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; D013745:Tetanus Toxoid