Improving pneumococcal vaccination uptake in a residency clinic: a case-inspired QI initiative aligned with updated CDC guidelines.

Abstract

<i>Streptococcus pneumoniae</i> remains a leading cause of preventable morbidity and mortality among adults, particularly those with chronic medical conditions, yet pneumococcal vaccination uptake in adult populations remains suboptimal. Residency-based primary care clinics face unique barriers to preventive care delivery, including staffing instability and competing clinical priorities. After identifying pneumococcal vaccination rates in our internal medicine residency clinic that were lower than the national average, we conducted a quality improvement initiative to increase vaccination uptake. Using Plan-Do-Study-Act cycles from September 2024 through February 2025, we implemented targeted, system-level interventions including certified medical assistant-led pre-queuing of pneumococcal vaccine orders, passive patient education via waiting room slideshows and quick response (QR) codes, and structured resident reminders through daily huddles and email reinforcement. Vaccination rates were tracked bi-weekly using electronic medical record data and analysed with run charts. Among adults aged ≥65 years, vaccination rates increased modestly from 62.7% to 64.3%. Following expansion of vaccine eligibility to adults aged ≥50 years, baseline vaccination rates decreased to 39.9% due to the enlarged eligible population; however, rates subsequently increased to 44.1% by the end of the intervention period, representing a 4.2% absolute improvement and meeting criteria for a sustained run chart shift. These findings demonstrate that small, multidisciplinary, workflow-integrated interventions can produce meaningful and sustainable improvements in adult pneumococcal vaccination uptake in residency clinic settings and may be adaptable to other resource-limited primary care environments.