Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment

Abstract

Purpose: Immunization rates in many cities in the United States remain suboptimal compared to Healthy People 2020 Goals and are lower than national averages. This study aimed to determine whether a lecture-based educational intervention targeted at nurses and medical assistants would improve vaccination rates. Methods: We conducted a quality improvement study in two urban academic family medicine clinics serving a predominantly Medicaid patient population as well as a sizable proportion of refugees. The intervention consisted of 3 lectures that were delivered to clinic nurses and medical assistants. Vaccinations in 1689 patients — 872 in the 3-month preintervention period, 817 in the 3-month postintervention period — were analyzed. Results: Following the educational intervention, a statistically significant increase was seen only in human papillomavirus vaccine immunization rates for 13–18-year-olds (from 90.7% [n = 54] to 100% [n = 45]; P = 0.036). When the results were stratified by clinic, only 1 site showed statistically significant increases in: pneumococcal polysaccharide vaccine (23-valent) for high-risk 19-to-64-year-olds (from 36.4% [n = 154] to 47.8% [n = 136]; P = 0.049); Haemophilus influenzae type B vaccine for 2-month-to-5-year-olds (from 91.1% [n = 112] to 97.3% [n = 111]; P = 0.048); and meningococcal conjugate vaccine (quadrivalent) for 13–18-year olds (from 85.2% [n = 27] to 100% [n = 26]; P = 0.042). No increases were seen for our study’s refugee patient population (n = 171), and a significant decrease of the second-dose measles, mumps, and rubella vaccine (P = 0.036) occurred in this subcohort. Conclusions: Ultimately, this quality improvement study demonstrated that educational interventions alone have a limited impact on increasing immunization rates.

Keywords

• education
• vaccination
• primary health care
• quality improvement
• refugees