Improving adult immunization rates in primary care clinics.

The goal of this effort was to improve adult immunization rates within a large urban health care system. To measure improvement efforts, we calculated each month the percentage of adults 65 years and older who leave clinic visits with up-to-date pneumococcal vaccination were calculated. This was accomplished through the development of three key aspects: standing orders, an immunization registry, and an algorithm to recommend vaccinations based on age and past vaccination history, but also on health history and risk factors for specific diseases.