title: Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center.
abstract: Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011-2012 and 2012-2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005-2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011-2012) and 9.4 % (2012-2013) compared to an average 6.9 % during influenza seasons 2005-2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35-40.3 %) and 56.1 % (95 % CI 40.9-73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012-2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.
authors.affiliation: Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Ave, Cleveland, OH, 44195, USA. grivasp@ccf.org.
authors.forename: Petros D
authors.initials: PD
authors.lastname: Grivas
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sumana
authors.initials: S
authors.lastname: Devata
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.|University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Khoriaty
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Boonstra
authors.affiliation: Hematology/Oncology, Munson Medical Center, Traverse City, MI, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Ruch
authors.affiliation: Division of Hematology/Oncology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: McDonnell
authors.affiliation: Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Leonel
authors.initials: L
authors.lastname: Hernandez-Aya
authors.affiliation: Hospice and Palliative Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Wilfong
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.|University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Smerage
authors.affiliation: Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ison
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joseph N S
authors.initials: JNS
authors.lastname: Eisenberg
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Silveira
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.|University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.|Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cooney
authors.affiliation: Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.|University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012621:Seasons; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Cancer center; Immunization; Influenza; Quality improvement; Vaccine