Improving the pneumococcal immunization rate for patients with diabetes in a managed care population: a simple intervention with a rapid effect

Jt Comm J Qual Improv. 2000 Sep;26(9):538-46. doi: 10.1016/s1070-3241(00)26045-8.


Background: Pneumococcal disease kills more people in the United States than any other vaccine-preventable bacterial disease, and a national health objective for the year 2000 is that at least 60% of eligible persons be immunized with pneumococcal vaccine.

Methods: An electronic care monitoring system was used to track immunization of patients with diabetes in a managed care plan who were receiving their care through a staff-model primary care clinic in Guam. In November 1998 a letter was sent to all patients not known to be immunized. The letter invited these patients to attend immunization clinics and waived usual copayment. Standing orders were also created for the clinic nurses to administer pneumococcal vaccines. In addition, a diabetes care status report was placed on each patient's medical record.

Results: The immunization rate for the 1,278 actively enrolled patients with diagnosed diabetes increased from 42% in October 1998 to 62% in January 1999. Compared to November 1995, 1996, and 1997, the number of pneumococcal immunizations increased more than 15-fold in November 1998.

Discussion: The combined use of patient outreach letters, special immunization clinics, standing orders, and practitioner reminders on medical records resulted in a rapid, marked increase in the pneumococcal immunization rate for patients with diabetes. The electronic care monitoring system is being used to target get interventions for improvement opportunities for an array of diabetes care measures, including regular foot care and eye exams.

MeSH terms

  • Adult
  • Aged
  • Chronic Disease
  • Diabetes Mellitus*
  • Female
  • Guam
  • Health Maintenance Organizations
  • Humans
  • Immunization / statistics & numerical data*
  • Male
  • Medical Records Systems, Computerized*
  • Middle Aged
  • Outcome Assessment, Health Care
  • Pneumococcal Infections / prevention & control*
  • Postal Service
  • Reminder Systems*