Improving Adult Immunization Rates
– Dr. Stephan Schroeder, Great Plains Quality Innovation Network
Despite immunization effectiveness in preventing morbidity and mortality due to infection, there remains a significant percentage of our population that has not received the recommended vaccines. A number of factors can contribute to the low rates. Misconceptions about the need for immunizations as well as concerns regarding effectiveness and safety remain barriers. The cost and insurance coverage of the medications, along with a somewhat complicated dose and timing of administration, can contribute to lower rates. Perhaps the most important issue may relate to the failure of clinicians to recommend and encourage these vaccines.
The Great Plains Quality Innovation Network (QIN) actively works with providers, partners and patients to implement practices that support the bold national goals of improved immunization. Great Plains QIN has developed a number of evidence-based resources to promote influenza, pneumococcal, and herpes zoster vaccination best practices, guidelines, and tools. We also hope to break down barriers for disparate and underserved populations. Home Health Agencies are another source of improving access to vaccination. Learning and Action Networks (LANs) are an interactive communication tool to give providers, community organizations, and patients the ability to share and learn. Great Plains QIN gives information about these options regarding immunizations on the GPQIN Web site.
Overcoming misconceptions about vaccination effectiveness and safety is a difficult challenge. It often requires direct conversations and strong recommendations on the part of the clinician to ensure the patient has a clear view of the evidence supporting routine, safe administration of the vaccines. Cost concerns were sometimes a reason why patients did not receive recommended vaccine. The Affordable Care Act requires insurers to cover the cost of immunization recommended by the ACIP (Advisory Committee on Immunization Practices), helping a number of patients overcome that obstacle.
Immunization Information Systems (IIS) are confidential population-based computerized data bases that record all immunization doses given by participating providers to patients in a given geopolitical area. Submitting information to immunization registries makes that information readily available to other providers and institutions such as public health clinics or schools. When it becomes widespread it offers providers historical immunization data to assist in keeping vaccinations up to date. This will help contribute to public health by reducing vaccine preventable disease and over-vaccination. This is a prime example of the benefit of interoperable EHR data in improving health care delivery.
Another area for patients to access immunizations would be participation by pharmacies. This offers a convenience for patients because of availability after hours as well as accessibility in underserved and rural areas. This could represent an effective way to increase vaccination rates.
Ultimately the aim is disease prevention. Evidence supports the use of vaccine and it remains a challenge for providers to increase rates and diminish illness.
Achieving the bold goals of the Healthy People 2020 listed below will be the effort of the Great Plains QIN.
- By 2019 a national absolute immunization rate of 70 percent, 90 percent for pneumonia, and 30 percent for zoster. Also an effort to reduce disparities among racial and ethnic minority and rural Medicare beneficiaries and dual-eligible Medicaid beneficiaries.
- By 2019 one million previously unimmunized Medicare beneficiaries will receive pneumonia immunization.
- By 2019 an absolute rate of 90 percent for adult immunization status assessment, appropriate immunizations or referrals, and documentation of Medicare beneficiary immunization status to the state or an IIS via CEHRT and other electronic methods.
If you would like additional information or resources, please feel free to contact me at Stephan.schroeder@greatplainsqin.org.
This article was written for South Dakota Medicine, the journal of the South Dakota State Medical Association (October 2016)