02 May Using Your Immunization Data to Improve Care
Do you get a headache looking at the ACIP schedule? It is certainly understandable since the immunization schedule is so complex, and there are so many combination vaccines. Do you really know how you are doing? Pediatricians often have a Lake Wobegone effect when it comes to our perceptions of care delivery. We have a natural tendency to overestimate our performance. I’m guilty as charged. Go get some baseline data to know your own rates. Start a Quality Improvement project in your office to figure out where you could improve, charge a team with implementing continuous QI and collect data to see if it’s working!
Start with putting the right information in front of the right person at the right time. Make sure everyone knows the schedule and has access to the information in the format that works best for them. Can your patients see their vaccines through their portal account to know if they are up to date? Does your front desk and triage staff know vaccine status and have the ability to schedule appointments for appropriate immunizations at each point of contact with the patient?
Where do you get good information? Get it wherever and however you can! From your state/local IIS (immunization information system), from your EHR (if you are lucky enough to have one that incorporates ACIP logic), or the CDC website. Track down printed ACIP schedules (they should be found all over your office), or from the CDC immunization scheduling tool that you can embed in your practice website. Don’t assume how your staff or families want to see that information, ask them.
Our practice has gone through several QI projects surrounding our immunization rates. Here are some real world examples:
We discovered our rotavirus vaccine rates were not as high as they should be. We figured out that one of our providers was not as strong in their recommendation of the vaccine to families as the rest of us were, and we addressed this as a team so we were giving consistent messages.
Like many of you, we struggled with how to get two doses of Hepatitis A in by the second birthday and observe the 6 month minimal interval rule. We put some standing orders in place and recalled overdue patients. We indeed improved our rates, but guess what? NCQA listened to feedback from the AAP and other vaccine champions, realized this was not realistic, and changed this metric!
We were really challenged with the timely completion of the 3 dose HPV series. After several suboptimal QI attempts, we now are scheduling doses 2 and 3 when we give the first shot. Patients who missed their appointment get called and reschedule. So far our data looks good!
So embrace this challenge to improve your immunization rates. Collect your data. Start Quality Improvement Initiatives within your practice and improve your rates. Then go back to everyone who cares and tell them how awesome you are! And go talk with your payers; they need good HEDIS scores. They need your data and your good rates. Make all your hard work pay off for your patients, your bottom line and for your community!