title: Increasing pneumococcal vaccination for immunosuppressed patients: a cluster quality improvement trial.
abstract: OBJECTIVE
  Pneumococcal vaccination is important for patients taking immunosuppressive medications, but prior studies suggest that most patients do not undergo vaccination. The aim of this study was to evaluate the effects of a point-of-care paper reminder form as a quality improvement (QI) strategy to increase the numbers of immunosuppressed patients being kept up-to-date with pneumococcal vaccination in a rheumatology practice.
  
  
  METHODS
  Selected rheumatologists at 5 ambulatory practice sites received a point-of-care paper reminder form to be applied to patients who were not up-to-date with pneumococcal vaccination. Interrupted time-series analyses were used to measure the effect of the intervention on the pneumococcal vaccination rates among patients, comparing the rates in the intervention group with those in a control group of rheumatologists who did not receive the intervention. Adjusted Cox proportional hazards models were examined to identify independent predictors of being up-to-date with pneumococcal vaccination.
  
  
  RESULTS
  We evaluated a total of 3,717 patients (66.0% with rheumatoid arthritis) who were taking immunosuppressive medications (74.1% women, mean age 53.7 years). Rheumatologists who received the intervention had a significant increase in the rate of patients who were up-to-date with pneumococcal vaccination, from 67.6% to 80.0% (P=0.006), in the time period following the intervention, compared to a rate that remained stable, from 52.3% to 52.0% (P=0.90), among patients in the nonintervention control group during this same time period. In regression models, positive predictors of being up-to-date with pneumococcal vaccination at the patient level included the following: having received the intervention (hazard ratio [HR] 3.58, 95% confidence interval [95% CI] 2.46-5.20), having a primary care physician affiliated with Brigham and Women's Hospital (HR 1.68, 95% CI 1.44-1.97), having a diagnosis of diabetes mellitus (HR 1.57, 95% CI 1.02-2.41), and being age 56-65 years at baseline, compared to age≤45 years (HR 1.24, 95% CI 1.01-1.51).
  
  
  CONCLUSIONS
  A QI strategy involving a simple point-of-care paper reminder form significantly increased the rate of being up-to-date with pneumococcal vaccination among patients receiving immunosuppressive medications in our rheumatology practices over a 6-month period.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. sdesai5@partners.org
authors.forename: Sonali P
authors.initials: SP
authors.lastname: Desai
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.forename: Lara E
authors.initials: LE
authors.lastname: Szent-Gyorgyi
authors.forename: Anna A
authors.initials: AA
authors.lastname: Bogdanova
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
authors.forename: Michael
authors.initials: M
authors.lastname: Weinblatt
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coblyn
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Greenberg
authors.forename: Allen
authors.initials: A
authors.lastname: Kachalia
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D019095:Point-of-Care Systems; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012219:Rheumatology
chemical_list: D022242:Pneumococcal Vaccines