Improving pneumococcal vaccine rates - Nurse protocols versus clinical reminders

OBJECTIVE: To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate. DESIGN: A prospective controlled trial. SETTING: Department of Veterans Affairs ambulatory care clinic. PATIENTS/PARTICIPANTS: There were 3,502 outpatients with scheduled visits d ivided into three clinic teams (A, B, or C). INTERVENTIONS: During a la-week period, each clinic team received one inter vention: (A) nurse standing orders with comparative feedback as well as pat ient and clinician reminders; (B) nurse standing orders with compliance rem inders as well as patient and clinician reminders; and (C) patient and clin ician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates. MEASUREMENTS AND MAIN RESULTS: Team A nurses assessed more patients than te am B nurses (39% vs 34%, p = .009). However, vaccination rates per total pa tient population were similar (22% vs 25%, p = .09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccinatio n rate for team C (p < .001). CONCLUSIONS: Nurse-initiated vaccine protocols raised vaccination rates sub stantially more than a physician and patient reminder system. The nurse-ini tiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vacc ination rates were similar.