Indian Health Service, Portland Area Assigned to Northwest Tribal Epidemiology Center, United States.
Indian Health Service, Great Plains Area, United States.
Vaccine. 2018 Aug 6;36(32 Pt B):4952-4957. doi: 10.1016/j.vaccine.2018.04.006. Epub 2018 Jul 7.
Government agencies, healthcare accreditation bodies and quality improvement organizations support the development of new quality measures. Composite quality measures use more than one measure to develop a broader assessment of healthcare system function. Currently, no composite measures for adult immunization coverage exist. Development of such measures could facilitate improvements in adult immunization coverage by focusing on measurement of receipt of all age-recommended vaccines.
We recruited five Indian Health Service (IHS) and Tribal health clinics to pilot an Adult Immunization Composite Measure (AICM). Data were collected monthly over seven months using a pre-programmed electronic health record (EHR) reporting tool (IHS sites); Tribal sites used third-party software or a programmable EHR reporting function. Data collected included: number of adults aged 19 years and over who were active users of the facility with at least two visits in the last three years; the cumulative number fully immunized per age-based recommendations for tetanus toxoid-containing vaccines, pertussis, zoster and pneumococcal vaccines; and the percent immunized for the AICM and for each individual vaccine. Coverage was calculated for three age groups: 19-59 years; 60-64 years; and 65 years and older.
All sites reported aggregate immunization data monthly from patient EHR records. For all adults 19 years and older, AICM coverage ranged from 49% to 87% at the end of the report period. Two sites showed increases in AICM coverage ≥ 3%. Improvements in zoster vaccine coverage accounted for most of the increase observed. One site specifically focused on improving zoster coverage as a result of using the AICM.
We demonstrated the feasibility of implementing a composite measure of adult immunization coverage. This is the first measure capable of monitoring immunization completeness, coverage improvement and overall adult vaccine program effectiveness for adults who receive all recommended, age-based vaccines.
政府机构、医疗保健认证机构和质量改进组织支持新质量措施的制定。综合质量措施使用一种以上的措施来更全面地评估医疗体系的功能。目前，尚无成人免疫覆盖的综合衡量标准。制定此类衡量标准可以通过关注所有推荐年龄疫苗的接种情况来促进成人免疫覆盖率的提高。
我们招募了五家印度卫生服务（IHS）和部落卫生诊所来试点成人免疫综合衡量标准（AICM）。在七个月的时间里，使用预先编程的电子健康记录（EHR）报告工具（IHS 站点）每月收集数据；部落站点使用第三方软件或可编程 EHR 报告功能。收集的数据包括：在过去三年中至少有两次就诊的 19 岁及以上设施活跃使用者的成年人数量；根据年龄推荐的破伤风类毒素、百日咳、带状疱疹和肺炎球菌疫苗的完全免疫人数；以及 AICM 和每种单独疫苗的免疫百分比。覆盖率计算了三个年龄组：19-59 岁；60-64 岁；65 岁及以上。
所有站点都从患者的 EHR 记录中每月报告汇总免疫数据。对于所有 19 岁及以上的成年人，在报告期末，AICM 覆盖率在 49%至 87%之间。有两个站点的 AICM 覆盖率增加了≥3%。带状疱疹疫苗覆盖率的提高是观察到的增长的主要原因。由于使用 AICM，一个站点专门致力于提高带状疱疹的覆盖率。
我们证明了实施成人免疫覆盖综合衡量标准的可行性。这是第一个能够监测接受所有推荐年龄疫苗的成年人免疫完整性、覆盖率提高和整体成人疫苗计划效果的衡量标准。
