MON-856 - Sustainability of a Clinical Workflow Intervention to Improve Vaccination Rates in Patients with Diabetes

Background: Improving vaccination rates in high-risk populations requires workflow interventions that are not only effective but sustainable. In this quality improvement (QI) project, we assessed the durability of a workflow modification aimed at improving the immunization rates among our patients with diabetes.

Methods: This project was conducted in an adult endocrinology practice. In an initial QI cycle during the 2024/2025 influenza season, we implemented a modification to our medical assistant (MA) rooming workflow to incorporate 1. Assessment of vaccination status 2. Reconciliation of vaccination information from the immunization information system (IIS) and 3. Using an established protocol, recommend, administer or refer eligible patients for vaccination. We held team meetings every 2 months to evaluate the implementation. This intervention was effective in improving our vaccination rates and was incorporated as a permanent part of the MA rooming workflow at our clinic.
In this current QI cycle, we assessed the rate of vaccine assessment done by the MAs for patients with no documentation of influenza vaccination in their medical record during the 2025/2026 influenza seasons. We held a single educational session at the beginning of the influenza season to orient our MAs to the rooming workflow.
We compared our MA vaccine assessment and reconciliation rate, and the overall clinic influenza vaccination rate for the current (2025/2026) QI cycle with the initial (2024/2025) QI cycle. We used two-sample proportion testing to compare the process measures and clinical outcomes.

Results: In the current QI cycle, there were 652 unique patient encounters that met the inclusion criteria with vaccine assessment completed in 245 patients (37.6%), compared to assessment in 458 (74%) out of 617 unique patient encounters during the initial QI intervention period. The medical record was reconciled with the IIS in 109 patients (16.7%) in the current QI cycle compared to 408 patients (66%) during the initial QI cycle. Our overall influenza vaccination rate was 37.2% during the current cycle compared to 49.8% in the initial QI cycle.

Conclusion: Our findings show that while our initial workflow modification was effective, adherence significantly declined after the active intervention. Key barriers to sustainability included staff turnover and the loss of momentum following the active QI phase. Long-term success requires implementation of sustainable staff training and engagement models.

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