Understanding Flu Vaccination Rates

A quality improvement (QI) project can be undertaken to understand conclusions from flu vaccination rates.

The QI project might analyze specific documentation, including: the number of flu vaccines given, declined, or for which there is no information in any given medical record.

This can be accomplished by reviewing pertinent flu data over the course of a week (or more) of visits, and the data can be analyzed by race, ethnicity, insurance type, sex, etc.

Example of How Flu Vaccination Rates Can be Addressed

At one practice in an urban center, the QI team documented flu vaccination rates of their patients by race, ethnicity, insurance coverage and gender (see below chart). These data points became a baseline to improve data collection as well as flu vaccination rates.

Received (%)Refused/Declined (%)No Data (%)
Total Population (N=5,341)2,051 (38.4)1,046 (19.6)2,244 (42.0)
White not H/L (n=1,022)487 (47.7)126 (12.3)409 (40.0)
Black not H/L (n=1,133)411 (36.3)263 (23.2)459 (40.5)
Hispanic/Latino (n=347)124 (35.7)61 (17.6)162 (46.7)
Medicare (n=1,333)675 (50.6)204 (15.3)454 (34.1)
Male (n=2,282)831 (36.4)442 (19.4)1,009 (44.2)
Female (n=3,059)1,220 (39.9)604 (19.7)1,235 (40.4)
Source: Christiana Care DRIVE Program, 2018

In this situation, since 42% of the population evaluated did not have data (in the “No Data” column), the first imperative of the QI activity was to make sure the health facility obtained more documentation for flu vaccination to fill those gaps.

Additional Tactics to Improve Flu Vaccination

There are many tactics the medical staff, beyond the physician, can use to inform and influence patients to receive the flu vaccine. Here are some key approaches:

Patient surveys
A nurse, medical assistant, or patient educator can survey patients in the waiting room about their views on the flu and vaccination.

Reinforcing recommendation for flu vaccination
A nurse or medical assistant can inform the patient, when they first bring the patient to their room, that the doctor is recommending they get a flu vaccine today. Patients who consent can be vaccinated. For the patients who express resistance, a note to their physician can be provided to facilitate further discussion.

Proactive activities to improve flu vaccination

  • Call or email all patients about the importance of flu vaccination and their availability for an appointment to receive the vaccine
  • Set up and inform patients of a “no appointment necessary for flu vaccination” policy or time period 
  • Create a dedicated flu vaccine desk at the health system or practice
  • Vaccinate throughout the entire flu season
  • Establish a flu vaccine advocate to lead efforts in the health system or practice
  • Set up standing orders to address various vaccination issues for patients within the health system or practice
  • Ensure adequate vaccine supply in the clinic and for different sections of the health system or practice

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