title: A quality improvement project significantly increased the vaccination rate for immunosuppressed patients with IBD.
abstract: BACKGROUND
  Immunosuppressed patients with inflammatory bowel disease (IBD) are at risk for vaccine preventable illnesses. Our aim was to develop a quality improvement intervention to measure and improve the proportion of immunosuppressed IBD patients receiving recommended vaccinations.
  
  
  METHODS
  Using a Plan-Do-Study-Act quality improvement model, a process was developed to improve the proportion of patients with immunosuppressed IBD receiving recommended vaccinations. A 1-page vaccine questionnaire was developed and distributed to consecutive patients being seen in the IBD clinic during influenza season. If recommended vaccines were due, patients were offered and given vaccines by a nurse at that visit. After a period of observation, a second Plan-Do-Study-Act was performed and processes were improved. Data were collected and analyzed using simple descriptive statistics, Pearson's chi-square, and analysis of means.
  
  
  RESULTS
  Over a 10-week period, 184 patients were included in the intervention. Eighty-four of these patients (46%) were receiving immunosuppressant medications. Of these 84 patients, 45 (54%) had received an influenza vaccination in the previous year and 26 (31%) had received a pneumococcal vaccination within the previous 5 years. After the quality improvement intervention, the rate increased to 81% for influenza (P < 0.001) and 54% for pneumococcal vaccination (P < 0.001). An analysis of means confirms a significant change from the overall mean before and after the intervention.
  
  
  CONCLUSIONS
  The vaccination rate for a high-risk IBD population was significantly improved using a quality improvement intervention. A similar approach can be taken for other processes associated with improved quality of care.
authors.affiliation: Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Parker
authors.forename: Laura
authors.initials: L
authors.lastname: Chambers White
authors.forename: Chad
authors.initials: C
authors.lastname: Spangler
authors.forename: Jessica
authors.initials: J
authors.lastname: Rosenblum
authors.forename: Shannon
authors.initials: S
authors.lastname: Sweeney
authors.forename: Emily
authors.initials: E
authors.lastname: Homan
authors.forename: Steven P
authors.initials: SP
authors.lastname: Bensen
authors.forename: L Campbell
authors.initials: LC
authors.lastname: Levy
authors.forename: Maria Conception C
authors.initials: MC
authors.lastname: Dragnev
authors.forename: Kristen
authors.initials: K
authors.lastname: Moskalenko-Locke
authors.forename: Pamela
authors.initials: P
authors.lastname: Rich
authors.forename: Corey A
authors.initials: CA
authors.lastname: Siegel
mesh_terms: D003093:Colitis, Ulcerative; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology*; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011379:Prognosis; D058996:Quality Improvement; D014611:Vaccination
chemical_list: D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines