Improving Pneumococcal Vaccination Coverage Among Older Adults in a Rural Hospital: A Plan-Do-Study-Act (PDSA)-Based Quality Improvement Project

Background Pneumococcal pneumonia remains a leading cause of morbidity and mortality among older adults, particularly in rural areas with limited healthcare access. Despite national recommendations, vaccination uptake in rural Japan remains suboptimal. Evidence suggests that patient education, reminder systems, and streamlined workflows can enhance preventive care in outpatient settings. This quality improvement (QI) project aimed to increase pneumococcal vaccination rates by at least 20% within three months among older patients in a rural Japanese hospital. Methods The project was conducted at Unnan City Hospital, a rural healthcare facility with a high proportion of older adults, from February to April 2025. Using the Plan-Do-Study-Act (PDSA) framework, three low-cost interventions were implemented: (1) patient and staff educational brochures; (2) electronic medical record (EMR)-based reminders; and (3) a standardized vaccination flowsheet. Eligible patients were aged ≥65 years with chronic conditions who regularly attended outpatient visits. Outcome measures included weekly vaccination rates; process measures included recommendation and reminder rates; and balance measures included staff satisfaction and perceived workload. We used run charts and interrupted time-series analysis (ITSA) to assess temporal changes; this method allows for the analysis of trends over time but has a limited ability to determine causality. Results Baseline vaccination coverage averaged 17.4% over eight months prior to the intervention. Following the QI project, vaccination rates increased to 65.0% within three months. ITSA demonstrated a significant post-intervention increase of 3.97 percentage points per week (p < 0.001). Physician recommendation rates improved from 24% to 83%, and reminder rates consistently exceeded 91%. Staff satisfaction with workflow and team communication improved, while perceived workload remained manageable. Qualitative feedback informed iterative adjustments, including daily vaccination limits and enhanced communication. Conclusions This multicomponent intervention was associated with substantial increases in pneumococcal vaccination rates among older adults in a rural hospital. Integrating EMR-based reminders, patient education, and interprofessional collaboration into routine practice proved feasible and scalable. This model may serve as a practical framework for enhancing adult vaccination in similar rural healthcare settings.