Invasive pneumococcal disease remains a leading cause of vaccine-preventable illness in the United States. Although rates of pneumococcal vaccination among non-institutionalized adults age 65 and older have increased substantially in the past 20 years, rates remain well below the target rate of 90% vaccination. In addition, racial disparities in vaccination rates persist. Current vaccination rates among adults age 65 and older are 68%; with rates of 73.1% for non-Hispanic white persons, 55.7% for non-Hispanic black persons, and 44.7% among Hispanic persons. These disparities do not appear to be due to access issues; rather, physician and patient attitudes have been implicated as root causes. A previous study (UPQUAL Utilizing Precision Performance Measurement to Improve Quality; D.W. Baker, PI; 1R18HS017163) created electronic health record (EHR) clinical decision support tools reminding physicians to offer pneumococcal vaccination to patients, and also allowed them to document instances of patient refusal. Three years from the inception of the study, among adults 65 and older, 91% of Whites had been vaccinated, compared to only 81% of Black patients in the practice. Furthermore, only 2.9% of Whites had a documentation of a refusal of pneumococcal vaccination, whereas 11.4% of African Americans refused the vaccination. Having no specific rationale for refusal included, it is unknown if refusal of vaccination represented a truly informed choice (i.e., difference in patient preferences) or a refusal due to inadequate communication about the benefits of vaccination. Thus, we sought to examine how to improve communication about pneumococcal vaccination to all patients, with a focus on both message design and implementation of novel communication tools in routine care (NU Center to Advance Equity in Clinical Preventive Services, D.W. Baker/K.A. Cameron, PI; P01HS021141). This presentation will provide an overview of our process and outcomes which included: (1) conducting individual interviews to better understand specific reasons for refusal of pneumococcal vaccination among Black patients age 65 and older; (2) developing a theoretically-based patient education video on pneumonia and pneumococcal vaccination; (3) implementing a clinical decision support tool within the EHR to prompt nurses to show the video to patients newly eligible for the vaccination (i.e., 65 or 66 years old with no documentation of receipt or refusal of pneumococcal vaccination within the EHR); and (4) using the patient portal within our EHR to deliver the video to patients scheduled for a clinic visit via a message sent prior to their clinic visit.
Kenzie A. Cameron, Ph.D., MPH, FACH
Division of General Internal Medicine and Geriatrics, Department of Medicine
Northwestern University Feinberg School of Medicine
Kenzie A. Cameron is a communication-trained health services researcher (PhD, Michigan State University) with expertise in theory-based message design, persuasion research, and innovative interventions promoting behavior change. Her work has informed clinical patient care by identifying and addressing key information needs of diverse populations; information which then serves as a foundation for the development of theoretically based targeted messages. Dr. Cameron uses mixed methodologies to increase individuals' use of preventive services including adult vaccinations and cancer screenings, with a focus on addressing racial and ethnic disparities. Dr. Cameron is passionate about mentoring, and has successfully mentored multiple faculty to career development awards, NIH R-series awards, and AHRQ grant awards. In 2016 she was named a Fellow of the Academy on Communication in Healthcare in recognition of her significant service and scholarship in the field of healthcare communication, and was awarded the Feinberg School of Medicine Mentor of the Year Award.