A multifaceted intervention to leverage electronic health records to improve vaccination rates for patients with rheumatoid arthritis

The overall goal of this project is to implement and test a system-level intervention designed to achieve very high levels of adherence to pneumococcal vaccination (PVX), annual influenza vaccination INFVX, and zoster vaccination (ZVX) before treatment with highly immunosuppressive therapies, including biologics and kinase inhibitors, among patients with rheumatoid arthritis (RA). The intervention will include: 1) electronic quality measurement and individual feedback to physicians, 2) computerized, point-of-care clinical decision support, and 3) population health management facilitated by an electronic data warehouse. Our specific objectives are to: 1) achieve ≥ 80% rate of initial PVX (or revaccination among those vaccinated only once previously), 2) achieve ≥ 60% rate of INFVX early during the 2013-14 season (i.e., prior to December 31, 2013), and 3) achieve ≥ 80% rate of offering ZVX and ≥ 50% rate of actual ZVX. (Note: We have set a lower goal for ZVX because it is often not covered by insurance). We chose these objectives because a) they represent rates substantially above our current rates, and b) we believe these are attainable goals for our practice and other practices around the country that would be interested in implementing this intervention (i.e., these represent rates attainable with best practices and can serve as “achievable benchmarks”). In addition to these primary objectives, our secondary objective is to assess physician and staff engagement in the intervention and to elucidate barriers to achieving optimal vaccination rates. This information will be important for our practice as we strive to improve further and for other practices that want to implement our intervention in their unique practice environment. We will use quantitative and qualitative methods to examine this objective.