title: Splenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic.
abstract: Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a population of asplenic veterans.
  
  
  
  Surgically asplenic patients actively receiving care in our health care system were identified via a database search. Patients were contacted via mailed letters and encouraged to attend an existing travel clinic with a new process designed for asplenic patients. In the clinic, patients were educated on the risks of asplenia and proper preventive precautions, a vaccination history was taken, and patients were administered any additional indicated vaccines.
  
  
  
  The database search yielded 113 patients; an additional 14 asplenic patients were identified and referred to the clinic by providers, and 2 were referred prior to planned splenectomy. Among all asplenic patients, the first-year referral rate to clinic was 38/129 (29%). During the first year of the intervention, there were increases in the rates of 3 of 4 recommended vaccinations: pneumococcal conjugate, 19% to 55% (P <.001); Haemophilus influenzae type B, 19% to 35% (P = .007); and meningococcal vaccine, 24% to 43% (P = .002). The pneumococcal polysaccharide vaccination rate increased from 91% to 93% (P = .62).
  
  
  
  Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.
authors.affiliation: Department of Medicine, Durham Veterans Affairs Medical Center, NC; Department of Hematology/Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. Electronic address: aaron.mitchell@unchealth.unc.edu.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, Durham Veterans Affairs Medical Center, NC.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Boggan
authors.affiliation: Department of Medicine, Durham Veterans Affairs Medical Center, NC.
authors.forename: Karen
authors.initials: K
authors.lastname: Lau
authors.affiliation: Department of Medicine, Durham Veterans Affairs Medical Center, NC.
authors.forename: David L
authors.initials: DL
authors.lastname: Simel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards*; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000209:etiology; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D058996:Quality Improvement; D013156:Splenectomy / Q000009:adverse effects; D014611:Vaccination / Q000706:statistics & numerical data; D014728:Veterans
keywords: Asplenic; Preventive medicine; Quality improvement; Splenectomy; Vaccines