Increasing the Rates of Postpartum Measles, Rubella, and Varicella Vaccination in Non-Immune Mothers: an Electronic Medical Record-Based Quality Improvement Intervention.

Abstract

Objective: Postpartum measles, mumps, rubella (MMR) and varicella vaccination is critical for non-immune mothers to prevent severe maternal and neonatal complications. Despite recommendations, vaccination rates remain suboptimal, particularly in completing the two-dose series. This study evaluates the impact of an electronic medical record (EMR)-based intervention on postpartum MMR and varicella vaccination rates.

Study design: A retrospective cohort study was conducted at two care centers within an urban tertiary healthcare system. Non-immune postpartum patients with public insurance who delivered between January 2021 and June 2022 and February 2023 and October 2024 were included in the pre- and post-intervention groups, respectively. The intervention, implemented in April 2023, modified the mandated postpartum checklist in the EMR to include measles immunity status and emphasize the necessity of completing the two-dose series for MMR and varicella. The primary outcome was the completion rate of the two-dose series, with secondary outcomes assessing provider adherence and patient acceptance. Statistical analyses included chi-squared and t-tests to compare pre- and post-intervention cohorts.

Results: A total of 468 patients were included (220 pre-intervention, 248 post-intervention). MMR series completion significantly increased from 2.3% to 34.9% (p<0.001). Varicella series completion showed a non-significant upward trend from 27.0% to 36.5% (p=0.112). Provider adherence improved, with fewer missed opportunities to offer the second dose at the postpartum visit (49.6% vs. 32.9%, p=0.004 for MMR). Patient declination rates remained stable.

Conclusion: Integrating vaccination reminders into the EMR significantly improved postpartum MMR series completion. While varicella rates showed a modest increase, persistent provider follow-up and patient education remain crucial. Future efforts should focus on addressing systemic barriers and enhancing patient outreach to further optimize postpartum vaccination completion.