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

From the 2021 HVPAA National Conference

Victor Quach (University of South Florida – Tampa, FL), Zaina Shahid (LVHN), Nabila Zamir, Marie O’Brien


Immunotherapy is a significant component in the treatment of autoimmune diseases, though they result in chronic immunosuppression. Patients on such therapies have a higher risk of hospitalization and death from vaccine preventable infections. The American College of Rheumatology recommends influenza vaccinations and pneumococcal vaccinations in such patients, though vaccination rates remain low, especially in the underserved population. Various factors may be contributing to the low adherence to vaccination guidelines, such as decreased compliance with vaccine guidelines and availability and cost of vaccines for a practice. A previous study at an internal medicine and a rheumatology outpatient clinic in Allentown, Pennsylvania, implemented an educational and protocolized vaccination program for patients on immunosuppressive medications. It showed an increase in overall adherence to vaccination guidelines. We implemented a similar education vaccination program and obtained an internal supply of influenza and pneumococcal vaccines at LVPP Rheumatology clinic to increase vaccination rates among the immunocompromised patient population.


The objective of this study was to determine if a vaccine initiative program can improve vaccination rates in LVPP Rheumatology patients.


An education session regarding CDC vaccination guidelines was administered to rheumatology fellows and resources were posted around the clinic as reminders of the vaccination schedules. Fellows began administering the vaccinations upon arrival of the supply of influenza vaccinations in September 2020. Pneumococcal vaccines were received and administered in November 2020. We conducted an IRB-exempt retrospective chart review analyzing vaccination rates before and after implementation of the vaccine initiative program. Vaccination rates were calculated, and a Chi-squared test was used to compare the two proportions.


In total, LVPP Rheumatology saw 208 patients in 2019 (pre-intervention) and 169 patients in 2020 (post-intervention) during the study timeframe (September 1st to December 31st of each year). For influenza vaccinations, 37.5% (n=78) of the pre-intervention patients and 36.7% (n=62) of the post-intervention patients were up to date (95% CI, -8.98 to 10.45; P=0.87). For Pneumococcal 13-Valent Conjugate vaccinations, 30.2% (n=63) of the pre-intervention patients and 34.9% (n=59) of the post-intervention patients were up to date (95% CI, -4.73 to 14.16; P=0.33). For Pneumococcal Polyvalent vaccinations, 29.3% (n=61) of the pre-intervention patients and 33.7% (n=57) of the post-intervention patients were up to date (95% CI, -4.94 to 13.80; P=0.36).


The implementation of an educational program and an in-house supply of vaccines administered by rheumatology fellows did not result in an increase in vaccination rates at LVPP Rheumatology. The study faced various barriers that may have impacted the results, such as exhausting the influenza vaccine supply in less than 2 months, a delay in shipment of the pneumococcal vaccines, and an increase in virtual visits and no shows due to the second surge of COVID-19. Despite these barriers, there were no significant decreases in vaccination rates at LVPP Rheumatology.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog