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Two Years of QUERI Intervention: Have Respiratory Vaccinations for Veterans with SCI Improved?

Weaver FM, Goldstein B, LaVela SL, Wallace C, Smith B, Legro M, Evans CT, Hammond M. Two Years of QUERI Intervention: Have Respiratory Vaccinations for Veterans with SCI Improved? Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.


Objectives:To increase the number of veterans with spinal cord injuries and disorders (SCIandD) receiving annual influenza vaccinations and a pneumococcal pneumonia vaccination (PPV).Methods:Veterans with SCIandD identified through the local registries of the 23 VA SCI Centers.In year one, patients were mailed reminder letters and education materials, and SCIandD providers received mailings and posters. By year two, computerized clinical reminders were modified to target all veterans with SCIandD for vaccination, and use of standing orders was encouraged. Mailings to patients and providers were repeated. Patients were surveyed in both years to determine self-reported vaccination rates.Results:The response rate to the survey in year 1 was 72% and 73% in year 2. In both years, non-respondents were less likely to be married and less likely to be white. In year 2, non-respondents were also younger than respondents (55.22 years v. 57.17 years; p < 0.01). In the first year, 62% of respondents indicated that they had received an influenza vaccination in the past six months, while 60% indicated that they had ever received a PPV. In year 2, 68% had received the influenza vaccination and 75% reported having received a PPV. The change in vaccination rates between year 1 and year 2 was statistically significant (p = 0.000). There was significant variability across sites in vaccination rates each year, ranging from 50% to 75% in the first year and 59% to 79% in the second year for influenza vaccines; and from 43% to 70% in the first year and 58% to 89% in the second year for PPV. Despite this variation, there was little difference in extent of implementation of the intervention across sites. The strongest predictors of vaccination were at the patient level.Implications:Vaccination rates in year one, following mailed reminders was higher than historical vaccination rates in veterans with SCI; and these rates increased significantly when system interventions were included. Multiple strategies were effective in improving vaccine rates. Institutionalizing these strategies (e.g., computerized reminders) should help to maintain rates over time.

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