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U.S. Department of Health and Human Services
Health Resources and Services Administration
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Testing for Improvement Case Study

The Problem 

Redline Health Clinic (RHC) provides primary care services in a rural community. The RHC Quality Improvement (QI) team monitors several quality care measures. Recently, the QI team noticed that many adult patients were not receiving appropriate influenza vaccinations per the adult immunization guidelines. The QI team met and reviewed the information collected from the practice management system. In analyzing data on adult influenza vaccinations, the team noted only 50 percent of patients aged 50 to 64 years received the influenza vaccine. This finding concerned the QI team, because annual influenza epidemics are a leading cause of death in the United States adult population. Given the risk for adults who do not receive influenza vaccinations, the team decided to focus its improvement efforts on increasing the rate of adult patients receiving an influenza vaccine. The QI team decided they would begin by setting a goal or an aim for the improvement project. The team reviewed State statistics when setting its goal and came up with the following aim statement:

Over the next 12 months, we will redesign the care systems of RHC to ensure that 80 percent of patients aged 50 to 64 years have been screened, and if clinically appropriate, will receive influenza immunization.

Initially, it was thought the care team members forgot to inform patients about the importance of proper vaccination for influenza, but the care team assured this point was stressed with patients. The QI team developed a simple and efficient approach to determine why patients were not receiving their influenza vaccines and decided to use sampling to further analyze the situation. To avoid burdening its overworked schedule, the QI team randomly chose 15 patients, aged 50 to 64 years, who were not vaccinated for influenza.

The team divided the 15 patient charts equally and phoned each patient to determine why he or she did not receive the influenza vaccine. Each team member had three patients to contact. The QI team successfully contacted 10 patients. Four received the influenza vaccine through a mobile van; two patients believed they would get the flu from the vaccine; two patients reported an allergy to eggs, and two patients reported "never been sick a day in their life" and felt the vaccination was unnecessary. Of the five not reached, three patients had disconnected phone numbers and two patients did not return the phone call.