Quality Improvement Strategies to Improve Influenza Vaccination Rates in the Resident Continuity Clinic Setting

Background:
As part of a cooperative agreement with the Centers for Disease Control and Prevention, the American College of Physicians developed a quality improvement program to address deficiencies in influenza vaccination rates in a variety of health care settings, including private practice, hospital-based ambulatory care, and resident continuity clinic programs.

Setting:
Our two featured practices are resident continuity clinics from St. Peter's University Hospital in New Brunswick, N.J. and Medical College of Wisconsin in Milwaukee, Wisc.

Population:
Three cohorts of physician practices were invited from a random, voluntary sample of 2,000 to attend 1-day training sessions in 2004, 2005, and 2006. Fifty-five practices received training, 39 practices provided baseline data, and 22 practices provided follow-up data, reporting on 4,992 patients. Four out of the 39 practices submitting data were residency clinics.

Project Description:
An interventional study using a pre-post design. Participants performed data abstractions and developed QI plans. Baseline data were compared with follow-up.

Results/Lessons Learned:
Aggregate immunization rates improved from 50% overall to 65%. The clinic programs experienced similar rates of improvement; however, vaccination rates for resident continuity clinics at baseline averaged 40%, and 53% at follow-up. The challenges of implementing an immunization QI program in the resident continuity clinic setting include the transitory nature of resident training, treating underserved populations with a host of acute and chronic needs, and language and cultural barriers. These resident clinics devised successful QI programs that emphasize data assessment, consistent education for both residents and faculty alike, mechanisms for measuring and tracking data results, as well as vaccine ordering and administration protocols. These programs demonstrated that the health care team is capable of implementing quality improvement initiatives that free the physician to perform higher-level tasks, which is particularly important when caring for chronically ill and underserved patients.