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Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center

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Abstract

Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011–2012 and 2012–2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005–2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011–2012) and 9.4 % (2012–2013) compared to an average 6.9 % during influenza seasons 2005–2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35–40.3 %) and 56.1 % (95 % CI 40.9–73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012–2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.

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Acknowledgments

We thank the UMCCC patients and families, administrators and leaders, health care providers, nurses, nursing managers, medical assistants, clerks, and social media managers for their significant contributions in implementing the intervention steps. We thank Gary Jankowski and Harriet Kramer (MCIT) and Kent Griffith (Department of Biostatistics) for their assistance with the data collection and analysis. We also specially thank Drs. Alissa Weber, Raymond Esper, Sadakatsu Ikeda, Binu Malhotra, Dawit Aregawi, and Arnold Monto, as well as Felicia Hurst, Louise Salamin, and Joann Sherman, for their critical input in this project.

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    Authors and Affiliations

    1. Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Ave, Cleveland, OH, 44195, USA

      Petros D. Grivas

    2. Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA

      Sumana Devata, Rami Khoriaty, Jeffrey Smerage, Kathleen A. Cooney & Francis P. Worden

    3. University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

      Rami Khoriaty, Jeffrey Smerage, Kathleen A. Cooney & Francis P. Worden

    4. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

      Philip S. Boonstra

    5. Hematology/Oncology, Munson Medical Center, Traverse City, MI, USA

      Joshua Ruch

    6. Division of Hematology/Oncology, University of Southern California, Los Angeles, CA, USA

      Kevin McDonnell

    7. Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA

      Leonel Hernandez-Aya

    8. Hospice and Palliative Medicine, Stanford University, Stanford, CA, USA

      Joshua Wilfong

    9. Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

      Michael G. Ison

    10. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

      Joseph N. S. Eisenberg

    11. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

      Maria Silveira

    12. Department of Urology, University of Michigan, Ann Arbor, MI, USA

      Kathleen A. Cooney

    Authors
    1. Petros D. Grivas
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    2. Sumana Devata
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    7. Leonel Hernandez-Aya
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    9. Jeffrey Smerage
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    12. Maria Silveira
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    14. Francis P. Worden
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    Corresponding author

    Correspondence to Petros D. Grivas.

    Ethics declarations

    The Institutional Review Board of the University of Michigan granted a waiver to conduct this QI project for the ’11–’12 and ’12–’13 seasons. This project was conducted according to institutional policies and medical ethics. The intervention was implemented across the entire UMCCC population as excluding patients may have been considered unethical.

    Funding

    There was no external funding.

    Additional information

    Petros D. Grivas and Sumana Devata are co-first authors.

    Petros D. Grivas and Sumana Devata contributed equally to this work.

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    Cite this article

    Grivas, P.D., Devata, S., Khoriaty, R. et al. Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center. J Canc Educ 32, 871–877 (2017). https://doi.org/10.1007/s13187-016-1017-2

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    • DOI: https://doi.org/10.1007/s13187-016-1017-2

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