Combining evidence and diffusion of innovation theory to enhance influenza immunization

Jt Comm J Qual Patient Saf. 2006 Aug;32(8):426-32. doi: 10.1016/s1553-7250(06)32056-9.


Background: Children and adolescents with chronic conditions such as asthma, diabetes, and HIV are at high risk of influenza-related morbidity, and there are recommendations to immunize these populations annually. At Cincinnati Children's Hospital Medical Center, the influenza immunization rate increased to 90.4% (5% declined) among 200 patients with cystic fibrosis (CF). Diffusion of innovation theory was used to guide the design and implementation of spread to other clinics.

Method: The main intervention strategies were: (1) engagement of interested, nurse-led teams, (2) A collaborative learning session, (3) A tool kit including literature, sample goals, reminder postcards, communication strategies, and team member roles and processes, (4) open-access scheduling and standing orders (5) A simple Web-based registry, (6) facilitated vaccine ordering, (7) recall phone calls, and (8) weekly results posting.

Results: Clinic-specific immunization rates ranged from 32.7% to 92.8%, with the highest rate reported in the CF clinic. All teams used multiple strategies; with six of the seven using four or more. Overall, 60.0% (762/1,269) of the population was immunized. Barriers included vaccine shortages, lack of time for reminder calls, and lack of physician support in one clinic.

Discussion: A combination of interventions, guided by evidence and diffusion of innovation theory, led to immunization rates higher than those reported in the literature.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cystic Fibrosis / complications
  • Diffusion of Innovation*
  • Documentation
  • Health Promotion / organization & administration
  • Hospitals, Pediatric / organization & administration*
  • Hospitals, University / organization & administration
  • Hospitals, Urban / organization & administration
  • Humans
  • Immunization Programs / organization & administration*
  • Influenza Vaccines / administration & dosage*
  • Nurses / organization & administration
  • Patient Care Team / organization & administration
  • Quality Assurance, Health Care / organization & administration*
  • Risk Factors


  • Influenza Vaccines