Improving the Combination Pneumococcal Vaccination Rate in Systemic Lupus Erythematosus Patients at an Adult Rheumatology Practice

Objective. The risk of developing invasive pneumococcal infection is 13 times higher in patients with systemic lupus erythematosus (SLE) in comparison with the general population. The US Centers for Disease Control and Prevention anticipates a US$7.6 million medical cost reduction by providing pneumococcal vaccination. The objective of this study was to improve the rate of combination pneumococcal vaccination (pneumococcal polysaccharide vaccine 23 + pneumococcal conjugate vaccine 13) in patients with SLE in our adult academic rheumatology practice. Methods. With the use of physician-and staff-based surveys, we analyzed the underlying barriers in providing vaccination. We then planned a multifaceted intervention including pre-visit planning, day-of-visit planning, weekly review, and monthly feedback. Results. Our project is one of the few studies planned to improve combination pneumococcal vaccination rates in adult patients with SLE and we report an impressive improvement from 10% baseline rate to 59% vaccination rate by the end of the study period. This highlights the role of planning an intervention with an integrated workflow and the importance of sharing performance data, which leads to high compliance among team members. Conclusion. The significant improvement in combination vaccination rate in eligible patients with SLE and the additional rise of vaccine rates seen in other eligible patients in the practice draws attention to the high adaptiveness of the intervention resulting in a true practice change. Our quality project design can serve as a model that can be adapted by other specialty clinics to achieve higher vaccination standards.