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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
A quality improvement initiative to increase pneumococcal vaccination coverage among children after kidney transplant
Kathryn Malone1,2, Stephanie Clark1, Jo Ann Palmer1
1Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Pneumococcal vaccination rates in pediatric kidney transplant recipients improved significantly, with coverage for PCV13 and PPSV23 increasing from 6% to 52% over 12 months. This QI initiative utilized an age-based algorithm and EHR reminders to boost immunization.
Area of Science:
- Pediatric Nephrology
- Immunology
- Public Health
Background:
- Pneumococcal vaccination rates are suboptimal in children with kidney transplants.
- Current guidelines recommend sequential pneumococcal vaccines: PCV13 followed by PPSV23.
- Kidney transplant recipients are at increased risk for pneumococcal infections.
Purpose of the Study:
- To improve pneumococcal vaccination rates in pediatric kidney transplant recipients.
- To implement an age-based vaccine algorithm and EHR-based reminders.
- To track missed vaccine opportunities and overall immunization coverage.
Main Methods:
- A quality improvement (QI) initiative was conducted.
- An age-based vaccine algorithm was developed.
- Electronic Health Record (EHR) system was used for tracking and reminders.
- Monthly reports monitored outcomes and missed vaccine opportunities.
Main Results:
- Initial increase in vaccine administration during visits from 4% to 33% within six months.
- A decrease in vaccine administration during visits to 8.7% by month 12.
- Overall increase in kidney transplant patients receiving both PCV13 and PPSV23 from 6% to 52% over 12 months.
Conclusions:
- An age-based algorithm and EHR system can effectively improve pneumococcal immunization coverage in high-risk pediatric transplant patients.
- Continuous monitoring and interventions are crucial for sustained vaccine coverage.
- Vaccine champions play a key role in tracking and improving immunization rates.
Abstract:
Pneumococcal vaccination rates among children receiving a kidney transplant remain suboptimal. Current practice guidelines in the United States recommend giving the PPSV23 after priming with the PCV13. We conducted a QI initiative to increase pneumococcal vaccine rates in our kidney transplant recipients by developing an age-based vaccine algorithm, obtaining vaccine records, and generating reminders for patients and clinicians. A monthly report from the EHR tracked outcomes. The process metric was missed vaccine opportunities, and the overall objective was to improve coverage with both the PCV13 and PPSV23. Over the first six months, we increased the percentage of visits where the vaccine was given from a baseline of 4% to 33%. However, by the end of the 12-month period, the percentage of eligible visits where the vaccine was given decreased to 8.7%. Nevertheless, over the 12-month observation period, we were able to increase the percentage of transplant patients receiving the PCV13 and PPSV23 from 6% to 52%. Utilizing an age-based algorithm and the electronic medical record, vaccine champions can track both missed visit opportunities and the number of vaccinated patients to improve pneumococcal immunization coverage for these high-risk patients.
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