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Dee Lacy, MD, PhD

Infectious Diseases, KP Fresno

Vaccination Program for Functional Asplenia

“A solution like this is so much more possible at a place like Kaiser Permanente—not only because of our advanced technology, but because there is a culture here in which the patient is the most important thing.”

As an infectious disease physician, Dee Lacy, MD, is accustomed to asking herself how her patients’ pain and suffering might have been prevented. But an encounter with one patient—a 33-year-old man who had been admitted to the hospital with meningitis and sepsis—left her certain that Kaiser Permanente and its members can do better.

In reading through the progress notes, Dr. Lacy discovered the patient had lost his spleen as a child. “People without a functional spleen are at greater risk of life-threatening infections, so it’s important they get a series of vaccinations,” she explains. “Not only is the dosing schedule complex, but because national vaccine recommendations for asplenia have been evolving, many patients, and sometimes physicians themselves, find it challenging to keep track.”

Dr. Lacy believed that creating a population management system for this group of patients would help identify them more easily and provide more support for encouraging them to stay up to date on their vaccines.

So in 2014 she launched a regionwide education campaign for physicians, pharmacists, nurses, and staff. Then she collaborated with TPMG Quality & Operations Support to configure our advanced medical record system to scan the medical records of all KP members in Northern California and identify which ones have asplenia. Today the system performs these scans every 4 months, identifying which asplenic patients are behind or due for the next vaccine in a series, and generating letters that help educate and encourage these patients to get their vaccines.

Prior to the implementation of the program, just 1.4% of patients were up to date. But within 2 years of rolling out the program across KP Northern California, 88% of patients are current on all vaccines.

“Part of the answer lies in creating systems that make it easier to do the right thing,” says Dr. Lacy. “But an equally important part is education. Just by tweaking a combination of elements, we established an effective safety net for these patients.”

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