Increased Pneumococcal immunisation rates among high-risk patients are a result of a quality improvement initiative.

In this study, which was published in the American Journal of Kidney Diseases (AJKD), adults aged 18 to 64 with stage 4 and stage 5 chronic kidney disease benefited from a quality improvement programme that used electronic best practise alerts within the electronic medical record, increasing pneumococcal vaccination rates from 53% to 70% (P 0.001).

Despite a higher incidence of pneumococcal pneumonia, higher mortality, and more cardiovascular problems in patients with chronic kidney disease (CKD) stages 4,5 and nephrotic syndrome compared to individuals without CKD, pneumococcal vaccination (PV) rates are low in these patients. Over a two-year period, researchers at the University of Pittsburgh launched a quality improvement (QI) study that involved the introduction of a best practise alert (BPA) in CKD clinics to increase PV rates among these high risk patients.

The intervention consisted of a BPA made to electronically screen patients for eligibility to receive PV treatment based on diagnosis, age, and immunisation status using a set of pre-established eligibility criteria. As the medical assistant (MA) evaluated the patient’s meds at the beginning of the visit, the BPA displayed on the EMR screen. The BPA gave the MA permission to request the vaccine or to provide documentation for a vaccine deferral or rejection. The BPA returned after six months if the PV was postponed for any reason. The BPA was disabled for a year if the patient refused the vaccine, and the clinician was notified to educate the patient more.

617 (53.8%) patients in the post-intervention group had received a prior vaccination, and 529 patients had BPA. In the post-intervention group compared to the pre-intervention group, there was a statistically significant increase in the proportion of patients who received at least one dose of the PV (70.2% vs 62.7%, P = 0.0008), which was primarily caused by an increase in PV from 53% to 70% in patients between the ages of 18 and 64 (P 0.001). The >=65y groups’ immunisation rates did not rise. The percentage of BPA compliance—defined as either the documentation of vaccines administered or prescribed or the justification for denial or deferral—was 45.9%.

These findings imply that PV administration during follow-up at CKD clinics is a missed opportunity, especially for those at high risk who are between the ages of 18 and 64.

The authors showed that implementing an MA-led intervention, specifically a decision aid as a BPA, can close this gap with no interference with workflow or an increase in the workload of physicians.


Journal reference:
Kapoor, S., et al. (2022) Best Practice Alerts in Electronic Medical Records to Improve Pneumococcal Vaccination in CKD. American Journal of Kidney Diseases.

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