S1267 Improving Vaccination Rates in Patients With Inflammatory Bowel Disease

Abstract

INTRODUCTION: Recent data suggests that inflammatory bowel disease (IBD) patients do not receive preventative services at the same rates as general medical patients. IBD patients are often treated with long-term immunosuppressive therapies which cause them to be at increased risk for vaccine-preventable infections. By identifying current gaps in care and developing a system for vaccine delivery, we set out to assume responsibility for this aspect of health maintenance for our IBD patients. We aimed to increase the vaccination rates in IBD clinic as compared to data obtained from the prior calendar year. METHODS: We performed a retrospective chart review to determine the reasons for missed opportunities for vaccination. We determined the current barriers and deficiencies in our current process and ecosystem as outlined in our process map and fish bone diagram (Figures 1 and 2). We then formulated various interventions and sequentially implemented these changes following a “Plan, Do, Study, Act” (PDSA) cycle. We first embedded a vaccination template within our clinic notes which allowed us to easily reference vaccine criteria for each patient. Following this, we updated our vaccination order menu, which provided an easier means to order vaccines in clinic. We also created return to clinic orders for vaccines series and a nurse clinic to administer these vaccines. We then worked with key shareholders to obtain all the vaccines in IBD clinic. RESULTS: A total of 399 patients were included in the preintervention group, and 132 patients were included in the postintervention group. The percentage of missed opportunities in the baseline data for influenza, PCV13/PPSV23, HBV, TDAP, and Zoster were 80%, 60%, 71.43%, 17.14%, 100%, respectively. This decreased to 22%, 22.22%, 22.22%, 16.67%, and 37.50% respectively by March 2020. With each vaccine, all percentages of missed opportunities in the post-intervention data from March 2020 were below the median, each with an additive effect. (Figure 3). CONCLUSION: We were able to see incremental gains in our interventions over time throughout this process. Our project was undoubtedly a positive experience for our patients. Moving forward, we anticipate continuing to see positive impacts from our interventions. We plan to share what we have learned with other GI clinics at the Atlanta VA and to other VA hospitals through the National VA Field Advisory Committee.Figure 1.: Process Map Process map outlining baseline patient flow in a visit. Oval: beginnings and endings, boxes: steps or activities, Diamonds: decisions.Figure 2.: Fishbone diagram Process analysis of cause and effect outlining barriers to vaccination.Figure 3.: a Baseline median of missed opportunities for each vaccination before the start of interventions on October 2019. b Run charts depicting percentage of missed opportunities (blue line) in relation to each intervention (gray arrow) and median (orange line). The percentage of missed opportunities for influenza, and PCV12/PPSV23 has a decreasing trend present since October 2019, which continues with each subsequent intervention. A decreased trend was beginning to develop for TDAP and Shringrex after the vaccine template was embedded in the clinic note. Fig 4. a Reasons for missed opportunities pre-intervention. B Reasons for missed opportunities post- intervention. The most common reason for pre and post-intervention was vaccination not being offered. The value decreased almost 70-80% for each vaccination post intervention.