Medical Studies

Influenza Vaccination: Part IV

What is the best method to immunize individuals? Vaccinations are typically delivered via scheduled or walk-in visits. Mass vaccinations, however, may offer a more efficient means to vaccinate large populations. The mass vaccination locations can take place at schools, convention centers, fair grounds, churches, parking lots or other places (see Arkansas’ Mass Flu Vaccine locations as an example).

Authors John Fontanesi, Linda Hill and colleagues take a more in depth look at this issue in their 2006 paper. The researchers found that while only 59% of individuals who saw a physician for a well visit received a flu shot, 99% of those who went to a mass immunization clinic received the flu shot. The cost to administer the vaccines at the two sites were remarkably similar (see below).

Direct Unit Costs

Routine Scheduled Visit Mass Vaccination
Physician ($61.43/hr) $3.07 $0.00
Nurse ($21.93/hr) $0.40 $1.10
Receptionist ($10.14/hr) $0.24 $0.68
Vaccine cost $8.73 $8.73
Syringe cost $1.24 $1.24
Overhead $5.04 $6.30
Total $18.72 $18.05

Thus, if we measure productivity as the cost for each person vaccinated, we see that mass clinics are about twice as productive. Regular office visits, however, are able to detect other health problems, whereas mass clinics only administer influenza vaccinations. Information gathering at mass vaccination clinics is minimal. The authors define efficiency as the quality of the visit divided by the cost of the visit. On this scale, the the study finds that office visits dominate mass vaccination clinics since they offer more patient education and better documentation of the encounter (see below). The authors conclude that “balancing critical resources…with the need to vaccinate as many at-risk patients…may be best accomplished by tightly integrating routine scheduled mass vaccination clinics with ambulatory care centers…”

Productivity (The lower score, the greater the productivity)

Routine Scheduled Visit Mass Vaccination
Mean Labor Cost $3.72 $2.45
Mean Overhead Cost $5.04 $9.90
Mean Materials cost $9.98 $9.98
Mean Patients seen/hr 2.87 8.9
Production Value 6.58 2.50

Efficiency (The higher the score, the greater the efficiency)

Routine Scheduled Visit Mass Vaccination
Nbr who could be vaccinated/hr 2.87 8.9
Probability of being vaccinated 59% 99%
Probability of health history reviewed 59% 0%
Probability VIS given 54% 71%
Probability vaccination documented 70% 45%
Efficiency Value 0.020 0.001

A second paper by Fontanesi and colleagues published in 2004 uses critical path analysis to analyze the rate of influenza immunization at 1) scheduled visits, 2) walk-in visits, 3) scheduled shot only visits, and 4) walk-in shot only. They find vaccination rates similar to the 2006 paper listed above. Immunization rates are 58%, 45%, 100%, and 98% respectively. The main indicators which contributed to a vaccination occurring were 1) the patient and provider discuss immunization, 2) the ratio of the number of providers to the number of registration staff, 3) the ratio of the number of providers to the number of exam rooms, and 4) the patient was asked about the examination in the exam room or before the exam. The authors wisely conclude the following:

“Critical path analysis of vaccination activities occurring during routine scheduled health encounters suggests that this is a complex task and should not simply be seen as an incremental activity added to the general health encounter. Critical path analysis also suggests that provider-patient discussion is more productively viewed as the culmination rather than the beginning of the vaccination process.”

  • Fontanesi; Hill; Olson; Bennett; Kopald; (2006) “Mass vaccination clinics versus appointments.” Medical Practice Management, vol March/April, pp. 1-7.
  • Fontanesi, J., A. M. Shefer, D. B. Fishbein, N. M. Bennett, M. De Guire, D. Kopald, K. Holcomb, D. W. Stryker and M. S. Coleman. “Operational Conditions Affecting the Vaccination of Older Adults.” American Journal of Preventive Medicine, 2004, 26 (4), pp. 265-270.