Bundled Clinic-Based Intervention Improved 2-Dose Flu Vaccine Compliance

Abstract

Over 200,000 patients are hospitalized annually for influenza-related illness; kids are more vulnerable than healthy adults. Vaccination is the best prevention. Thus, the CDC recommends annual flu vaccination for all children aged 6 months through 18 years of age, with specific guidance that previously unimmunized children aged 6 months through 8 years should receive a 2-dose vaccine series during their first season of flu vaccination. Prior research demonstrates that while two doses of vaccine decreased the number of office visits for influenza-like illness (ILI), one dose of vaccine had no effect on visits for ILI. Average national compliance with the 2-dose recommendation is less than ideal. A retrospective analysis estimated 37% overall compliance. The aim of this project was to design a clinic-based intervention to improve observance of the 2-dose flu vaccine recommendation for patients less than 2 years of age. The bundled intervention included provider education, reminder cards, and phone call reminders. The provider education session reiterated the flu vaccination recommendations, specifically the 2-dose recommendation. The reminder cards were given to patients’ families at the time of their initial vaccination indicating the need for a second immunization in one month’s time. Finally, families were called at least 1 month after administration of their initial flu vaccine to remind them of the need for a second dose. The E-immune immunization database was used to analyze the 2-dose vaccine compliance rates for patients less than 2 years old who received their first flu vaccine from October 2010 - February 2011. Our clinic population’s compliance initially mirrored the national population at 37.5%. There was a statistically significant improvement in the 2-dose vaccine compliance rate after implementation of the bundled intervention (53.8%, p<0.005). This process improvement project demonstrated that a clinic-based, bundled intervention comprised of physician education, reminder notes, and phone follow-up produced a statistically significant improvement in the 2-dose flu vaccine compliance rate for children less than 2 years old.