Back to Basics: Five Steps to Better Influenza Vaccination Rates


Getting more patients immunized against the flu does not require complicated strategies.

Fam Pract Manag. 2017 Nov-Dec;24(6):30-33.

Author disclosures: no relevant financial affiliations disclosed.

Influenza results in up to 710,000 hospitalizations and up to 56,000 deaths per year in the United States.1 Although the effectiveness of flu vaccines varies, vaccination is still the best way to reduce flu-related illnesses and deaths. In addition to protecting individuals, a high vaccination rate within a population also offers “herd immunity,” which reduces the chance of a flu outbreak and helps protect the most vulnerable, such as infants and others unable to receive the vaccine. Since 2010, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended flu vaccination for patients six months and older who do not have contrain-dications.1 Because of the impact on quality and cost, Medicare and other payers are increasingly incorporating flu vaccination rates as an individual quality measure in value-based payment models. So improvements can affect not only your patients' health but also your bottom line.

Unfortunately, the flu vaccine rate remains low. Only 59.3 percent of children and 41.7 percent of adults received an influenza vaccination during the 2015 – 2016 flu season.2

Our family medicine practice has 48 faculty members and providers in downtown Philadelphia serving 35,000 patients through more than 80,000 visits per year. More than half of our patients are racial or ethnic minorities, and many of our patients come from underserved communities. To meet the needs of such a large and diverse patient population, our practice leaders must navigate many competing quality priorities.

After becoming part of the Delaware Valley Accountable Care Organization (ACO) in 2015, we were charged with improving our flu vaccination rate of 66 percent, which was below our goal. We considered several system- and provider-level strategies and were able to improve our 2016 – 2017 flu vaccination rate to 82 percent using five key tactics. (See “Key tactics for improving flu vaccination rates.”)


  1. Find a champion

  2. Use standing orders

  3. Optimize your documentation

  4. Provide regular reminders

  5. Give ongoing feedback

1. Find a champion

Identify a physician or other health professional in your office to lead the flu vaccination campaign. The champion should be both familiar with current vaccination guidelines and enthusiastic about improving flu vaccine rates. He or she should communicate regularly with office providers and staff to share current vaccination information and bolster enthusiasm and commitment to flu vaccination. In some offices, a champion also recruits an immunization coordinator from among the providers or staff to oversee logistics of vaccine purchasing, storage, administration to patients,

About the Authors

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Amy Cunningham is a postdoctoral research fellow in the Department of Family and Community Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia....

Dr. Stoeckle is a clinical instructor and population health fellow in the Department of Family and Community Medicine.

Dr. Diaz is an assistant professor in the Department of Family and Community Medicine and assistant medical director and quality improvement director for Jefferson Family Medicine Associates in Philadelphia.

Dr. Valko is a professor in the Department of Family and Community Medicine and medical director of Jefferson Family Medicine Associates.

Dr. Arenson is an alumni professor and chairwoman of the Department of Family and Community Medicine.

Author disclosures: no relevant financial affiliations disclosed.



show all references

1. Key facts about seasonal flu vaccine. Centers for Disease Control and Prevention website. Updated Oct. 6, 2017. Accessed Oct. 6, 2017....

2. Flu vaccination coverage, United States, 2015-16 influenza season Centers for Disease Control and Prevention website. Updated Sept. 29, 2016. Accessed Sept. 6, 2017.

3. Hainer BL. Vaccine administration: making the process more efficient in your practice. Fam Pract Manag. 2007;14(3):48–53.

4. Workshop handouts from the Immunization Action Coalition. Take a Stand! website. Accessed Sept. 7, 2017.

5. Vaccination programs: standing orders. The Community Guide website. Updated March 2015. Accessed Sept. 6, 2017.

6. Klatt TE, Hopp E. Effect of a best-practice alert on the rate of influenza vaccination of pregnant women. Obstet Gynecol. 2012;119:301–305.

7. Pierson RC, Malone AM, Haas DM. Increasing influenza vaccination rates in a busy urban clinic. J Nat Sci. 2015;1(3):e57.

8. Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA. 2012;307(16):1702–1708.

9. Buffington J, Bell KM, LaForce FM. A target-based model for increasing influenza immunizations in private practice. J Gen Intern Med. 1991;6(3):204–209.


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