Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115637

Marlene M. Lugg, DrPH, Panorama CIty Medical Center, Southern California Kaiser Permanente, 13652 Cantara Street, South 1 Bldg, Panorama City, CA 91306, (818) 375-3078, marlene.m.lugg@kp.org

BACKGROUND: Southern California Kaiser Permanente serves 3 million members in 11 medical centers and 60 medical offices. A centralized immunization tracking system (KITS) contains over 25 million immunizations. To increase medical management of chronic and high-risk conditions, a separate Care Management Summary Sheet (CMSS) was developed by Regional Pharmacy Services, which shows pharmaceuticals, laboratory tests, and immunization status (from KITS. CMSS sheets are printed in advance for scheduled outpatient visits and on admission for inpatients. KITS automatically prints out the immunization history on check-in for outpatient visits.

OBJECTIVES: To improve immunization rates for high-risk persons.

METHODS: Beginning in 2003, if a CMSS printout indicated "Patient in High Risk Category for pneumonia, no record of pneumococcal immunization in KITS", a pre-printed physician order form was inserted into the chart. Nurses follow-up that the physician completes the form. The immunizations ordered are given before the patient is discharged. For outpatient visits, no physician form is needed for the immunization to be given under a standing order protocol. All immunizations are immediately entered into KITS in real-time by the person administering the immunization.

In 2004, a study was carried out to access the quality of the combined inpatient and outpatient immunization efforts. Inpatient's CMSS were printed out, and divided into two major groups: those needing immunizations and those who did not. KITS was double-checked to make sure the CMSS form's history was correct.

For outpatients, immunization deficiencies are automatically printed on the patient visit data sheet when the patient's membership card is scanned on check-in. This serves as a provider reminder of immunization needed. Monthly audits are conducted by each medical center's Immunization Coordinator, for outpatient visits requiring immunizations, using the visit data sheet, KITS and chart review when needed. Results of deficiencies are presented to the individual physicians and the department administrator.

During the study period, almost 96% of in-patients were in compliance with pneumococcal vaccine recommendations upon admission. Those who were not up-to date were followed up during the hospitalization. The high rate of compliance on admission is largely due to the quality of reminder, recall, and physician reminders in the ambulatory care setting. Overall, the at-risk patients showed a 92+% immunization rate, which was up form 65% three years before.

CONCLUSIONS: Using both inpatient and outpatient monitoring of pnuemococcal immunizations, with appropriate follow-up, increases the pneumococcal immunization rates to over 92% for high-risk groups.

Learning Objectives:

• Participants will be learn and discuss computerized and manual methods to increase immunization rates for high risk persons.

Keywords: Quality Improvement, Immunizations

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation