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A Quality Improvement Project Significantly Increased the Vaccination Rate for Immunosuppressed Patients with IBD

Parker, Siddhartha MD*; Chambers White, Laura MPH; Spangler, Chad MD*; Rosenblum, Jessica MPH; Sweeney, Shannon MPH; Homan, Emily MPH; Bensen, Steven P. MD*; Levy, L. Campbell MD*; Dragnev, Maria Conception C. ARNP*; Moskalenko-Locke, Kristen RN*; Rich, Pamela*; Siegel, Corey A. MD*,†

doi: 10.1097/MIB.0b013e31828c8512
Original Clinical Articles

Background: Immunosuppressed patients with inflammatory bowel disease (IBD) are at risk for vaccine preventable illnesses. Our aim was to develop a quality improvement intervention to measure and improve the proportion of immunosuppressed IBD patients receiving recommended vaccinations.

Methods: Using a Plan-Do-Study-Act quality improvement model, a process was developed to improve the proportion of patients with immunosuppressed IBD receiving recommended vaccinations. A 1-page vaccine questionnaire was developed and distributed to consecutive patients being seen in the IBD clinic during influenza season. If recommended vaccines were due, patients were offered and given vaccines by a nurse at that visit. After a period of observation, a second Plan-Do-Study-Act was performed and processes were improved. Data were collected and analyzed using simple descriptive statistics, Pearson’s chi-square, and analysis of means.

Results: Over a 10-week period, 184 patients were included in the intervention. Eighty-four of these patients (46%) were receiving immunosuppressant medications. Of these 84 patients, 45 (54%) had received an influenza vaccination in the previous year and 26 (31%) had received a pneumococcal vaccination within the previous 5 years. After the quality improvement intervention, the rate increased to 81% for influenza (P < 0.001) and 54% for pneumococcal vaccination (P < 0.001). An analysis of means confirms a significant change from the overall mean before and after the intervention.

Conclusions: The vaccination rate for a high-risk IBD population was significantly improved using a quality improvement intervention. A similar approach can be taken for other processes associated with improved quality of care.

Article first published online 24 May 2013

*Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

Reprints: Dr. Corey A. Siegel, Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756 (e-mail:

The authors have no conflicts of interest to disclose.

Supported by a Crohn’s and Colitis Foundation of America career development award and by grant number K23DK078678 from the National Institute of Diabetes and Digestive and Kidney Diseases (C.A.S.). C. A. Siegel serves as the Chairperson of the Crohn’s and Colitis Foundation of America Quality Improvement Taskforce.

Received December 19, 2012

Accepted February 9, 2013

© Crohn's & Colitis Foundation of America, Inc.
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