KEYWORDS:
Influenza Vaccination Seniors

BACKGROUND:
The process of vaccinating older adults against influenza in outpatient settings has not been adequately described. The few that have observed the process of care have consistently identified provider recommendation as a critical factor. However, outpatient visits embrace a wide variety of operational demands, health conditions, patient expectations and physician beliefs, the complexity of which suggests that provider recommendation may be more accurately conceptualized as the end result of a series of interactions, rather than as begining of the immunization process. Vaccine availability, presence of the patient’s chart or the time constraints may have as much influence on provider behavior as do patient and provider beliefs or characteristics

OBJECTIVE:
This study performs Critical Path Analysis using data from standardized workflow analysis collected from 16 facilties in 3 States to better understand the operational factors supporting adult influenza immunization in the ambulatory care setting

METHOD:
Direct observations of patient encounters were coded for presence of specific activities, time to complete activites and operational charecteristics such as provider-to-staff ratios. Classification and regression methods were used to model the interactions with “received an immunization” as the dependent variable. Binary recursive partitioning identified sets of variables having the greatest predictive ability to correctly classify patients who received a flu shot.

RESULT:
58% of patients observed were vaccinated. Critical Path Analysis identified a sequence of clinical activities successfully predicting 97% of immunizations and 75% of the missed opportunities.

CONCLUSION:
1)Vaccinating older adults proves to be a complex task requiring specific clinical activities, adequate time and operational support. It is not an incremental activity added to the general health encounter.
2) Resource requirements for vaccinating older adults are not trivial. The difference in total clinic time spent by patients who were vaccinated compared to patients who did not receive an immunization, is greater then the two minutes required to administer the shot.

LEARNING OBJECTIVES:
1) Understand how operational conditions influence delivery of influenza vaccination
2) Learn about critical path analysis