Improvement of Vaccination Rates in Adult Patients at High Risk for Pneumococcal Disease: A Focus on Reasons for Decline of Vaccination

S pneumoniae is the most common cause of pneumonia (community acquired) with 15% of patients developing invasive disease. In the US in 2010, invasive pneumococcal infection caused an estimated 4,000 deaths. As studies have shown, a sizable portion of hospital admissions, and the associated morbidity and mortality are potentially preventable through vaccination. Currently, administration of the pneumococcal vaccine is suboptimal despite efforts to increase vaccination rates in both outpatient and inpatient settings. In order to meet Centers for Medicare & Medicaid Services (CMS) pneumococcal immunization measure, IMM-1, which mirrors the goals of Healthy People 2020, Yale-New Haven Hospital (YNHH) has created a systematic approach to identify and vaccinate all patients that meet the criteria set by CMS. Although this approach has captured more at-risk patients in need of vaccination, vaccination rates have only marginally increased due to high patient refusal rates (40%). Therefore, the objective of this study is to identify reasons why patients decline the pneumococcal vaccine. Following the identification of the reasons why patients refuse the pneumococcal vaccine, the goal is to implement formalized strategies to increase the rate of patient's acceptance to receive the pneumococcal vaccine. These strategies may include targeted education for health-care professionals on why patients refuse pneumococcal vaccination and tools to help health-professionals mitigate the reasons for vaccine refusal. Additionally, patient education efforts will be tailored to the patient's reason for refusal.