Ann Arbor physician uses quality improvement projects to increase childhood immunization rates
How do you get doctors and patients excited about something as routine as childhood immunizations? The answer is passion, according to Dr. Heather Burrows, who practices at the University of Michigan Pediatrics in Ann Arbor.
For Dr. Burrows and her staff, immunizations are an important part of the practice. She has implemented several strategies to increase immunization rates and continues to look for ways to educate parents and new doctors as well.
The office has completed a large quality improvement project looking at adolescent immunization to identify ways to offer vaccines at every possible visit. That project has expanded to childhood immunizations. “Nurses and medical assistants print out the MCIR for every patient scheduled and highlight when vaccinations are due,” says Dr. Burrows. They follow that procedure for both scheduled visits and sick visits. “This way there are fewer missed opportunities,” she says. “It helps us stay on track and get patients back on schedule.”
The doctors in Dr. Burrows’ practice give the registry results to patients and highlight the vaccines that are required. “It’s another reminder for families that this is important,” says Dr. Burrows. “There are times when people come in for sick visits and it’s not the right time to vaccinate. If we know they’re coming back we may wait. But we would vaccinate a teenager at a visit for a sprained ankle because they may not come in as often for well visits.”
Dr. Burrows’ office also uses electronic medical records to run gap reports to identify children scheduled for vaccines. “We also reach out to families who are due for vaccines. We sometimes have to contact them to make sure they come in for well care,” she says.
In addition, a new pilot project with the University of Michigan reminds parents about the importance of vaccines and well visits with a birthday letter reminder. “We still spend a lot of time with families who still have questions about the safety of vaccines,” Dr. Burrows says. “Most of the time, we can get families to understand the importance of vaccines. Other times it takes a while. It’s sobering to share stories about children who have succumbed to childhood diseases because they weren’t vaccinated. That is a powerful message,” she says.
To help in their efforts, the office has outreach posters in the exam rooms about vaccines. “When nurses meet with women for prenatal visits, we always mention vaccines,” says Dr. Burrows.
The office has also worked with residents to develop a curriculum so they can communicate a consistent message about vaccinations to patients and to learn how to talk to families about vaccines. “We’ll be expanding that to the medical school to develop those skills before they do their residency,” says Dr. Burrows.
There’s a lot to know about vaccinations. You have to be up to date on the correct information, says Dr. Burrows. “You also have to know what your parents are reading and hearing to be able to give them correct information.”
Consistency of message is also important. ”Everyone in the practice, including six faculty and 16 residents, hears the same message,” says Dr. Burrows. “To be effective in improving vaccination rates, everyone has to be on board and passionate.”
Although the practice's rates have improved, they’re not yet at 100 percent. “It’s easier to fix the process and identify patients and missed opportunities,” says Dr. Burrows. “So we’re always looking for new ways to pass on our message in the most effective way.”