Mhaskar, Rahul

O\u27Brien, Marie S, DO

Quach, Victor

Ross, James, MD, FACP

Shahid, Zaina, MD

Slenker, Amy, MD

Zamir, Nabila, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works USF-LVHN SELECT Practice-Based Vaccine Initiative to Increase Vaccination Rates in Immunocompromised Patients Victor Quach Zaina Shahid MD Nabila Zamir MD Amy Slenker MD James Ross MD, FACP See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/select-program  Part of the Medical Education Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Victor Quach; Zaina Shahid MD; Nabila Zamir MD; Amy Slenker MD; James Ross MD, FACP; Rahul Mhaskar; and Marie S. O'Brien DO © 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaThe implementation of an educational program and an in-house supply of vaccines administered by rheumatology fellows did not result in a significant increase in vaccination rates. Despite the nationwide downward trend in vaccination rates during the pandemic and our limited supply of vaccines, LVPP Rheumatology was able to maintain similar vaccination rates as the previous year with the implementation of the vaccination initiative. It remains imperative that we continue to maintain and increase vaccination rates among our vulnerable patient population. Increasing vaccination rates improves patient access to and quality of care and reduces overall cost, which are the three pillars of the Iron Triangle. By obtaining a supply of vaccines in the clinic, we hoped to increase access and facilitate the process for patients so that they can adhere to CDC evidence-based vaccination guidelines, increasing their quality of care. Costs would be reduced by decreasing future hospitalizations from preventable infectious diseases. Expanding our supply of vaccines with the hopeful end of the pandemic may further improve vaccination rates at LVPP Rheumatology.Practice-Based Vaccine Initiative to Increase Vaccination Rates in Immunocompromised PatientsStudy Patients:• From Sept-Dec 2019, there were 339 patient encounters with 208 unique patients (0% virtual visits)• From Sept-Dec 2020, there were 280 patient encounters with 169 unique patients (15% virtual visits)Study Outcomes:• Influenza (95% CI, -8.98 to 10.45; P=0.87)– Pre-Intervention: 37.5% (n=78) of patients were up to date– Post-Intervention: 36.7% (n=62) of patients were up to date• Pneumococcal 13-Valent Conjugate (95% CI, -4.73 to 14.16; P=0.33)– Pre-Intervention: 30.2% (n=63) of patients were up to date– Post-Intervention: 34.9% (n=59) of patients were up to date• Pneumococcal Polyvalent (95% CI, -4.94 to 13.80; P=0.36)– Pre-Intervention: 29.3% (n=61) of patients were up to date– Post-Intervention: 33.7% (n=57) of patients were up to dateFigure 1. Percent of Patients Vaccinated Before and After Vaccine Initiative Program.• The implementation of an educational program and an in-house supply of vaccines did not result in a significant increase in any of the three vaccination rates at LVPP Rheumatology• Other studies have found increases in vaccination rates with point-of-care vaccinations and education initiatives4,5• The discrepancy between this study and the previous studies is most likely due to the circumstances under which this study was conducted– Given the COVID-19 pandemic, there was an increase in virtual visits, a nationwide downward trend of vaccination rates per the CDC6,7, increased fear of contracting COVID-19 and nationwide stay-at-home orders, and a delayed shipment in pneumococcal vaccine shipments– Number of influenza vaccines was also limitedWe conducted an IRB-exempt retrospective chart review analyzing vaccination rates before and after implementation of the vaccine initiative program at LVPP Rheumatology outpatient clinic, a clinic dedicated to serving the local underserved communityStudy Design:• We administered an education session regarding CDC vaccination guidelines to rheumatology fellows and fellows were trained to administer vaccines• Flu vaccine administration (40 doses) started in September 2020 and pneumococcal vaccine administration (30 doses of each) started in November 2020 due to late shipment• We used Webi to obtain deidentified patient vaccination data from Sept-Dec 2019 (pre-intervention) and Sept-Dec 2020 (post-intervention)• Vaccination rates were determined by calculating the number of patients up to date with each vaccine and dividing it by the total number of unique patients, and a Chi-squared test was used to determine significanceVaccine Criteria:• Patients were considered up to date if they received an influenza vaccine between Sept-Dec of the respective year, a single dose of pneumococcal 13-conjugate, and a dose of pneumococcal polyvalent vaccine within past 5 years of encounter data either at LVPP Rheumatology or elsewhereVictor Quach MS4, Zaina Shahid MD, Nabila Zamir MD, Amy Slenker MD, James Ross MD, Rahul Mhaskar PhD, Marie O’Brien DOBackground Methods Results DiscussionConclusionsProblem Statement• Immunotherapy is a significant component in treatment of autoimmune diseases, though they result in chronic immunosuppression• Patients on such therapies have an increased risk of hospitalization and death from vaccine-preventable infections1,2• The American College of Rheumatology recommends influenza and pneumococcal vaccinations in immunosuppressed patients, but vaccination rates remain low3• Lack of physician and patient awareness on vaccination guidelines, availability and cost of vaccines, and patient perception of vaccine safety may contribute to the low vaccination rates• We implemented an education vaccination program and obtained an internal supply of influenza and pneumococcal vaccines at Lehigh Valley Physician Practice (LVPP) Rheumatology clinic to increase vaccination rates in the clinicThe objective of this study was to determine if a vaccine initiative program will improve vaccination rates in rheumatology patients.© 2018 Lehigh Valley Health NetworkReferences1. Glueck T, Mueller-Ladner U. Vaccination in patients with chronic rheumatic or autoimmune diseases. Clin Infect Dis 2008; 46: 1459-652. Keystone EC. Does anti-tumor necrosis factor-α therapy affect risk of serious infection and cancer in patients with rheumatoid arthritis?: a review of longterm data. J Rheumatol. 2011 Aug;38(8):1552-62. 3. Singh JA, Saag KG, Bridges Jr. SL, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot EA, Mcnaughton C, Osani M, Shmerling RH, Curtis JR, Furst DE, Parks D, Kavanaugh A, O’Dell J, King C, Leong A, Matteson EL, Schousboe, JT, Drevlow B, Ginsberg S, Grober J, St. Clair WE, Tindall E, Miller AS, Mcalindon T. “2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.” Arthritis Care & Research. 2015. American College of Rheumatology.4. Soliman A, Aggarwa S, Kreitman K, Erickson K, Aleem A, O'Brien M, (2019, November 11). Practice-Based Education Program to Increase Vaccination Rate in Patients on Immunotherapeutic Agents. Poster Presented at: American College of Rheumatology Annual Conference. Atlanta, Georgia.5. Wong CI, Billett AL, Weng S, et al. A Quality Improvement Initiative to Increase and Sustain Influenza Vaccination Rates in Pediatric Oncology and Stem Cell Transplant Patients. Pediatric Quality & Safety. 2018 Jan-Feb;3(1):e052.6. Bramer CA, Kimmins LM, Swanson R, et al. Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep 2020;69:630–631.7. Hong K, Zhou F, Tsai Y, et al. Decline in Receipt of Vaccines by Medicare Beneficiaries During the COVID-19 Pandemic — United States, 2020. MMWR Morb Mortal Wkly Rep 2021;70:245–249.37.530.2 29.336.7 34.9 33.701020304050Influenza Pneumococcal 13-ValentConjugatePneumococcalPolyvalentPercent of Patients VaccinatedPERCENT OF PATIENTS VACCINATED BEFORE AND AFTER VACCINE INITIATIVE PROGRAMPre-Intervention Post-Intervention

Practice-Based Vaccine Initiative to Increase Vaccination Rates in Immunocompromised Patients

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Practice-Based Vaccine Initiative to Increase Vaccination Rates in Immunocompromised Patients

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