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Vaccination Status and Adherence to Quality Measures for Acute Respiratory Tract Illnesses
Mersine A Bryan1,2, Annika M Hofstetter3,2, Tamara D Simon3,2
1Department of Pediatrics, University of Washington, Seattle, Washington; mersine@uw.edu.
Insights
Children not up-to-date (UTD) with vaccinations received lower adherence to overuse quality measures and higher adherence to underuse quality measures. This suggests clinicians provide more care for unvaccinated children with respiratory illnesses.
Area of Science:
- Pediatric Healthcare
- Infectious Disease Prevention
- Clinical Quality Improvement
Background:
- Assessing the impact of vaccination status on clinical practice is crucial for optimizing pediatric care.
- Understanding clinician adherence to quality measures can identify areas for practice improvement.
Purpose of the Study:
- To evaluate the association between children's vaccination status and clinician adherence to quality care measures for acute respiratory tract illnesses.
- To determine if vaccination status influences the application of overuse and underuse quality indicators.
Main Methods:
- A multicenter prospective cohort study included 2302 children (0-16 years) with specific acute respiratory tract illnesses.
- Provider-documented up-to-date (UTD) vaccination status was the primary predictor variable.
- Clinician adherence was measured using the Pediatric Respiratory Illness Measurement System (PRIMES) composite scores for overuse and underuse.
Main Results:
- 92% of participants were UTD on vaccinations.
- No significant difference in overall PRIMES scores was observed between UTD and non-UTD children.
- Non-UTD children showed significantly lower adherence to overuse indicators and higher adherence to underuse indicators.
Conclusions:
- Clinicians appear to "do more" for hospitalized children who are not up-to-date with vaccinations.
- Findings suggest potential over-treatment or under-treatment related to vaccination status.
- Further research is needed to understand the clinical and economic implications of these observed adherence patterns.
Objectives:
To assess the relationship between vaccination status and clinician adherence to quality measures for children with acute respiratory tract illnesses.
Methods:
We conducted a multicenter prospective cohort study of children aged 0 to 16 years who presented with 1 of 4 acute respiratory tract illness diagnoses (community-acquired pneumonia, croup, asthma, and bronchiolitis) between July 2014 and June 2016. The predictor variable was provider-documented up-to-date (UTD) vaccination status. Our primary outcome was clinician adherence to quality measures by using the validated Pediatric Respiratory Illness Measurement System (PRIMES). Across all conditions, we examined overall PRIMES composite scores and overuse (including indicators for care that should not be provided, eg, C-reactive protein testing in community-acquired pneumonia) and underuse (including indicators for care that should be provided, eg, dexamethasone in croup) composite subscores. We examined differences in length of stay, costs, and readmissions by vaccination status using adjusted linear and logistic regression models.
Results:
Of the 2302 participants included in the analysis, 92% were documented as UTD. The adjusted mean difference in overall PRIMES scores by UTD status was not significant (adjusted mean difference -0.3; 95% confidence interval: -1.9 to 1.3), whereas the adjusted mean difference was significant for both overuse (-4.6; 95% confidence interval: -7.5 to -1.6) and underuse (2.8; 95% confidence interval: 0.9 to 4.8) composite subscores. There were no significant adjusted differences in mean length of stay, cost, and readmissions by vaccination status.
Conclusions:
We identified lower adherence to overuse quality indicators and higher adherence to underuse quality indicators for children not UTD, which suggests that clinicians "do more" for hospitalized children who are not UTD.
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