Improving Influenza Vaccination Rates in Iowa Hospital Health Care Workers (HCWs): Results of Three Years of Statewide, Provider-Based Performance Improvement Effort

Background: The Iowa Healthcare Collaborative (IHC) is a provider-based, not-for-profit entity established to improve healthcare outcomes, quality and value in Iowa. Because of persistently low influenza immunization rates in HCWs nationally, the IHC, advised by a statewide task force of infectious diseases, hospital infection control, and public health experts, set a goal that by 2010, 95% of Iowa hospital HCWs would be annually immunized with influenza vaccine.

Setting: Iowans are served by approximately 79,000 HCWs employed in 117 acute care, rural referral and urban hospitals.

Population: Iowa’s population (nearly 3 million) is distributed equally between rural and urban settings

Project Description: An evidence-based toolkit for hospitals on the importance of HCW influenza immunization and the project rationale was made available. An on-line system was provided for voluntary submission of annual HCW influenza immunization rates by participating hospitals over 3 influenza seasons (2006-07, 2007-08 and 2008-09). HCW immunization rates for hospitals were computed using definitions and formula agreed to in advance. Each participating hospital was shown its own rate, but was blinded to rates of other hospitals.

Results/Lessons Learned: In season 1, 86% of 117 Iowa hospitals participated and reported hospital rates ranged from 44 to 99%.  In season 2, 100% of hospitals participated and reported rates ranged from 47 to 100%. In season 3, 100% of hospitals participated and reported rates ranged from 53 to 100%. The annual mean hospital HCW influenza vaccination rates increased over the 3 seasons (68% to 76% to 79%) and were above national rates of 10%-40% (1989-2003, cited by HICPAC/ACIP). In all 3 seasons, urban and large hospitals had vaccination rates that were lower than those of rural and small hospitals. In season 2, hospitals that used declination statements had influenza vaccination rates 12.6% higher than hospitals that did not use declination statements.