Improving documentation of vaccinations for patients with rheumatologic diseases

ABSTRACT

Purpose of Study Vaccinations are an essential part of preventative medicine and provide for the improvement of public health by preventing the spread of infectious diseases. Patients with autoimmune rheumatic diseases have chronic illnesses that often require prolonged or lifelong immunosuppression or immunomodulation therapy to promote both quality-of-life and survival. Less than half of these patients receive the most common vaccinations despite having a higher risk of vaccine-preventable infections than the general population. The evaluation of immunization status and discussion of vaccines have remained under-prioritized in the medical community due to a wide variety of factors. The use of smart phrases has been shown in previous studies to positively affect clinical outcomes. Improvement in the documentation rate with this method can prompt discussion of immunizations and reduce the rate of suboptimal vaccination coverage in this high-risk patient population. We aimed to increase documentation of vaccinations by ten percent over four weeks using a novel vaccine smart phrase. This will prompt the provider to discuss patient-specific vaccination strategies and has the potential to improve vaccination rates in UMMC rheumatology patients. Methods Used A baseline assessment through chart review was performed for four weeks immediately prior to implementation (March 14, 2022). Then, educational material on dot phrase implementation was provided electronically to four rheumatology fellows and a two week adjustment period was allowed. The impact of the smart phrase intervention was defined as the difference in the frequency of discussion (via documentation) of vaccinations (COVID, influenza, pneumococcal, and zoster) per clinical in-person encounter four weeks before and four weeks after implementation. Inclusion criteria were any patient with a rheumatology fellow provider seen in adult rheumatology clinic at UMMC. A total of 345 patient encounters were evaluated. Summary of Results: Results showed that implementation of the dot phrase was unable to meet our goal of increased vaccination documentation by 10%. In fact, a 5% overall decrease in the frequency of vaccine documentation was observed. [Figure presented] Conclusion(s) We suspect that an increased patient-to-provider ratio may have pressured the system and led to decreased discussion of vaccinations. Additionally, while we were careful to choose a time for assessment which avoided COVID-19 peaks, proximity to a recent spike may have artificially increased baseline vaccination discussion relative to post-implementation. Lastly, patient charts were not reviewed from prior to the pre-intervention assessment period in an effort to prioritize sample size. It is possible that a discussion on vaccination status was not repeated in subsequent clinic visits. Future studies seek to increase the length of time of the assessment in order to minimize these effects. Additionally, fellow education should be provided in person with the opportunity for further discussion and fellow input. Copyright © 2023 Southern Society for Clinical Investigation.