Increasing Equity in Tdap Vaccination in Pregnancy: Using Data to Drive a Quality Improvement Project [15F

Abstract

INTRODUCTION: National guidelines recommend the Tdap vaccine during 27-36 weeks gestation to confer immunity to the neonate. At the University of New Mexico, Title V-funded clinics that provide prenatal care for uninsured women do not provide on-site Tdap, but refer women to the Department of Health (DOH) for vaccination. Other university clinics stock the vaccine on-site. We sought to compare rates at Title V clinics to university-based obstetrical and family medicine clinics. METHODS: A retrospective review of electronic health records was performed for women who received prenatal care at Title V, obstetric, and family medicine clinics in 2018. Patients were crossed checked in the New Mexico Statewide Immunization Information System to include DOH records. Statistical significance was assessed using two-sample tests of proportion and a logistic regression. RESULTS: Results from 372 charts revealed the rate for Title V clinics (31.94%) was significantly lower than the rates for obstetrical clinics (71.91%, P<.02) and family medicine clinics (90%, P<.001). Controlling for demographic factors, women at Title V clinics were 80% less likely to get a Tdap vaccine than women who went to obstetric clinics (P<.001). CONCLUSION: Title V clinic patients are less likely to receive Tdap than patients who receive care at clinics with Tdap on-site. Providing on-site Tdap vaccination for uninsured pregnant women is a matter of health equity. Advocating for change by addressing specific barriers is ongoing. The results of this study have guided a comprehensive quality improvement project, resulted in the donation of on-site vaccines, and inspired a larger DOH study.