P3208 - Quality Improvement Initiative Improves Pneumococcal Vaccination Rates in Adult Patients with Celiac Disease

Award: ACG Outstanding Research Award in the Small Intestine Category (Trainee)

Award: Presidential Poster Award

Kaitlin Payne, MD¹, Emily Trommer, RN, BSN¹, Claire Jansson-Knodell, MD², Alberto Rubio Tapia, MD^3
1Cleveland Clinic, Cleveland, OH; ²Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; ³Cleveland Clinic Foundation, Cleveland, OH

Introduction: Patients with celiac disease (CD) have an increased risk of pneumococcal infections due to functional asplenia. The 2023 ACG update on diagnosis and management of CD suggests pneumococcal vaccination for all CD patients. A previous retrospective chart review by the authors revealed a baseline pneumococcal vaccination rate of only 21% in CD patients. We aimed to improve rates of pneumococcal vaccination in CD patients through a quality improvement project.

Methods: A prospective quality improvement initiative was performed. Inclusion criteria were adult patients seen in the celiac program at Cleveland Clinic between September 27, 2023 and May 3, 2024. Patients who were seen virtually or already fully vaccinated (defined as PPSV23 and PCV13 or PCV20) were excluded. An educational handout designed by the authors was given to patients [Figure A] who were then offered the pneumococcal 20-valent conjugate vaccine (PCV20). Data was collected on baseline vaccination rates, whether handout was provided, and whether the patient was vaccinated during the visit. One-sample test for binomial proportion was used to calculate significance for the intervention compared to historic numbers, and chi-squared test was used to calculate the odds ratio of vaccination after intervention.

Results: In total, 93 celiac patients were seen in the office during the window of intervention [Figure B]. Thirty-three patients were already vaccinated and thus excluded along with 148 celiac virtual patients. Of the remaining 60 eligible patients, 42 were given the handout and a majority went on to receive PCV20 vaccination at their visit. This increase in vaccination rates compared to historic numbers was significant (p< 0.0001) and remained so looking at intention-to-treat of all eligible patients (p< 0.0001). Of patients who did not receive the flier, 2/18 were vaccinated in the office. Patients were significantly more likely to get vaccinated after receiving the handout (OR 13.0; 95% CI, 2.6-64.2; p=0.0016).

Discussion: Patients with CD are insufficiently vaccinated against pneumococcal disease; providing educational resources and administering PCV20 during in-person GI office visits is an effective strategy to increase vaccination rates. Further research including stakeholder interviews with patient representation would help us better understand if educational material, provider discussion, Hawthorne effect, or vaccine availability was the main driver for the project’s success.



Disclosures:


Kaitlin Payne, MD¹, Emily Trommer, RN, BSN¹, Claire Jansson-Knodell, MD², Alberto Rubio Tapia, MD³. P3208 - Quality Improvement Initiative Improves Pneumococcal Vaccination Rates in Adult Patients with Celiac Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.