{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:45:31Z","timestamp":1787067931419,"version":"build-2736575974"},"reference-count":27,"publisher":"The Journal of Rheumatology","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To improve pneumococcal vaccination (PV) rates among rheumatology clinic patients on immunosuppressive therapy in the outpatient settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This quality improvement project was based on the pre\u2013post intervention design. Phase I of the project targeted patients with rheumatoid arthritis from 13 rheumatology clinics (January 2013\u2013July 2015) on immunosuppressive therapy to receive the pneumococcal polysaccharide vaccine (PPSV23). In the Phase II study (January 2016\u2013October 2017), all patients on immunosuppressive medications regardless of diagnosis were targeted to receive PPSV23 and the pneumococcal conjugate vaccine (PCV13). The best practice alerts (BPAs) for both PVs were developed based on the Centers for Disease Control and Prevention guidelines, which appeared on electronic medical records for eligible patients at the time of assessment by the medical assistant. The BPA was designed to inform the vaccination status and enable the physician to order the PV, or to document refusal or deferral reasons. Education regarding vaccine guidelines, BPAs, vaccination process, and regular feedback of results were important project interventions. The vaccination rates during pre\u2013post intervention for each study phase were compared using chi-square test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During phase I, PPSV23 vaccination rates improved from a 28% preintervention rate to 61.5%\n                      <jats:italic>(P<\/jats:italic>\n                      &lt; 0.0001). During phase II, 77.4% of patients had received either PPSV23, PCV13, or both, compared to 49.6% of patients in the preintervention period (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.0001). The documentation rates (vaccine received, ordered, patient refusal and deferral reasons) increased significantly in both phases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Electronic identification of vaccine eligibility and implementation of BPAs with capabilities to order and document resulted in significantly improved PV rates. The process has potential for self-sustainability and generalizability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3899\/jrheum.200806","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T17:35:51Z","timestamp":1608140151000},"page":"1472-1479","source":"Crossref","is-referenced-by-count":14,"title":["Improving Pneumococcal Vaccination Rates in Rheumatology Patients by Using Best Practice Alerts in the Electronic Health Records"],"prefix":"10.3899","volume":"48","author":[{"given":"Heena S.","family":"Sheth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera D.","family":"Grimes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Rudge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Ayers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry W.","family":"Moreland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary S.","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2020,12,15]]},"reference":[{"key":"2022062114102633000_48.9.1472.1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofu024"},{"key":"2022062114102633000_48.9.1472.2","first-page":"1473","article-title":"Immune status and risk for infection in patients receiving chronic immunosuppressive therapy","volume":"32","author":"Gl\u00fcck","year":"2005","journal-title":"J Rheumatol"},{"key":"2022062114102633000_48.9.1472.3","first-page":"816","article-title":"Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"61","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022062114102633000_48.9.1472.4","first-page":"521","article-title":"Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6\u201318 years with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"62","year":"2013","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022062114102633000_48.9.1472.5","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2009.11.2069"},{"key":"2022062114102633000_48.9.1472.6","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2012.05.2550"},{"key":"2022062114102633000_48.9.1472.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-006-0441-9"},{"key":"2022062114102633000_48.9.1472.8","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21641"},{"key":"2022062114102633000_48.9.1472.9","doi-asserted-by":"publisher","DOI":"10.1002\/art.23721"},{"key":"2022062114102633000_48.9.1472.10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-1-200901060-00009"},{"key":"2022062114102633000_48.9.1472.11","unstructured":"Langley GJ , Nolan KM , Nolan TW , Norman CL , Provost LP . 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