BACKGROUND:
Despite the availability of safe and effective influenza and pneumococcal vaccines, immunization rates for adults are still not optimal. The implementation of evidence based systems in primary care is critical to improving vaccination rates. READII Rochester is a program designed to address racial and ethnic disparities with a strong focus on assessing the applicability of office-based interventions to diverse patient populations.

OBJECTIVE:
To translate evidence based strategies to increase vaccination rates to inner city primary care practices serving racially and ethnically diverse patients.

METHOD:
Medical clinics and practices serving the target population were recruited. Under the supervision of a senior social worker, outreach workers implemented a structured tracking, recall/reminder and outreach (TRO) program for patients 65 years and older.

RESULT:
The program was successfully implemented in 8 sites with -- patients. All patients > 65 years of age were entered into a site based data system and followed with the structured TRO protocol. Outreach workers followed patients with mailings, telephone calls, and home visits. The intervention resulted in an improvement in the pneumococcal vaccination rate from approximately 60 to 90%.

CONCLUSION:
Structured TRO is successful in increasing vaccination rates to very high levels in clinics and practices with limited resources and traditionally under-vaccinated patients. Disparities in adult vaccination rates can be addressed through the implementation of targeted office-based strategies. Barriers and assets were identified in all phases of implementation.

LEARNING OBJECTIVES:
1. Name three potential assets to establishing a tracking, reminder/recall, and outreach program for adult immunizations.
2. Name three potential barriers to establishing such a program.
3. Describe methods for overcoming barriers.