Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Inflamm Bowel Dis. 2013 Aug;19(9):1809-14. doi: 10.1097/MIB.0b013e31828c8512.
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.
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.
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.
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.
患有炎症性肠病（IBD）的免疫抑制患者有罹患疫苗可预防疾病的风险。我们的目的是开发一种质量改进干预措施，以衡量和提高接受推荐疫苗接种的免疫抑制 IBD 患者的比例。
使用计划-执行-研究-行动（Plan-Do-Study-Act）质量改进模型，制定了一个提高接受免疫抑制 IBD 患者推荐疫苗接种比例的过程。制定并向在流感季节在 IBD 诊所就诊的连续患者分发了一份 1 页的疫苗问卷。如果需要推荐的疫苗，护士将在就诊时为患者提供并接种疫苗。经过一段时间的观察，进行了第二次 Plan-Do-Study-Act，并改进了流程。使用简单描述性统计、Pearson's chi-square 和均值分析收集和分析数据。
在 10 周的时间内，共有 184 名患者参与了干预。其中 84 名患者（46%）正在服用免疫抑制剂。在这 84 名患者中，45 名（54%）在过去一年中接种了流感疫苗，26 名（31%）在过去 5 年内接种了肺炎球菌疫苗。在质量改进干预措施之后，流感疫苗接种率提高到 81%（P<0.001），肺炎球菌疫苗接种率提高到 54%（P<0.001）。均值分析证实，干预前后的总体均值有显著变化。
使用质量改进干预措施，显著提高了高危 IBD 人群的疫苗接种率。可以采用类似的方法来改善与提高医疗质量相关的其他流程。
