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Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized
Evan W Orenstein1,2,3, Omar ElSayed-Ali4, Swaminathan Kandaswamy1
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Insights
A clinical decision support (CDS) strategy significantly increased influenza vaccine administration in hospitalized children. This quality improvement initiative improved vaccination rates through user-centered design and stepwise implementation.
Area of Science:
- Pediatric Health
- Infectious Disease Prevention
- Health Informatics
Background:
- Hospitalized children face higher risks of influenza complications.
- Influenza vaccine coverage is notably low in this vulnerable pediatric population.
- Effective vaccination strategies are crucial, especially during public health crises like the COVID-19 pandemic.
Purpose of the Study:
- To develop and assess a clinical decision support (CDS) strategy aimed at increasing seasonal influenza vaccination rates among eligible hospitalized children before discharge.
Main Methods:
- A quality improvement study utilized a sequential crossover design across three hospitals within a large pediatric health system.
- The intervention involved a user-centered clinical decision support (CDS) system, including default vaccine orders, presumptive vaccination scripts, and just-in-time clinician education.
- Vaccination rates were compared between an intervention group (using the CDS order set) and concurrent/historical control groups over two influenza seasons.
Main Results:
- The intervention group achieved a 31% influenza vaccine administration rate, significantly higher than concurrent controls (19%) and historical controls (14%).
- Adjusted analyses indicated that the odds of receiving the influenza vaccine were 3.25 times higher in the intervention group compared to historical controls.
- The study demonstrated a statistically significant improvement in vaccination rates (P < .001) through the implemented CDS strategy.
Conclusions:
- User-centered clinical decision support (CDS) is an effective strategy for substantially improving influenza vaccination rates in hospitalized children.
- The stepwise implementation of CDS interventions provides a rigorous approach to quality improvement in pediatric healthcare.
- This approach offers a practical and effective method to enhance vaccine uptake and reduce influenza-related complications in pediatric hospital settings.
Importance:
Hospitalized children are at increased risk of influenza-related complications, yet influenza vaccine coverage remains low among this group. Evidence-based strategies about vaccination of vulnerable children during all health care visits are especially important during the COVID-19 pandemic.
Objective:
To design and evaluate a clinical decision support (CDS) strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge.
Design, Setting, And Participants:
This quality improvement study was conducted among children eligible for the seasonal influenza vaccine who were hospitalized in a tertiary pediatric health system providing care to more than half a million patients annually in 3 hospitals. The study used a sequential crossover design from control to intervention and compared hospitalizations in the intervention group (2019-2020 season with the use of an intervention order set) with concurrent controls (2019-2020 season without use of an intervention order set) and historical controls (2018-2019 season with use of an order set that underwent intervention during the 2019-2020 season).
Interventions:
A CDS intervention was developed through a user-centered design process, including (1) placing a default influenza vaccine order into admission order sets for eligible patients, (2) a script to offer the vaccine using a presumptive strategy, and (3) just-in-time education for clinicians addressing vaccine eligibility in the influenza order group with links to further reference material. The intervention was rolled out in a stepwise fashion during the 2019-2020 influenza season.
Main Outcomes And Measures:
Proportion of eligible hospitalizations in which 1 or more influenza vaccines were administered prior to discharge.
Results:
Among 17 740 hospitalizations (9295 boys [52%]), the mean (SD) age was 8.0 (6.0) years, and the patients were predominantly Black (n = 8943 [50%]) or White (n = 7559 [43%]) and mostly had public insurance (n = 11 274 [64%]). There were 10 997 hospitalizations eligible for the influenza vaccine in the 2019-2020 season. Of these, 5449 (50%) were in the intervention group, and 5548 (50%) were concurrent controls. There were 6743 eligible hospitalizations in 2018-2019 that served as historical controls. Vaccine administration rates were 31% (n = 1676) in the intervention group, 19% (n = 1051) in concurrent controls, and 14% (n = 912) in historical controls (P < .001). In adjusted analyses, the odds of receiving the influenza vaccine were 3.25 (95% CI, 2.94-3.59) times higher in the intervention group and 1.28 (95% CI, 1.15-1.42) times higher in concurrent controls than in historical controls.
Conclusions And Relevance:
This quality improvement study suggests that user-centered CDS may be associated with significantly improved influenza vaccination rates among hospitalized children. Stepwise implementation of CDS interventions was a practical method that was used to increase quality improvement rigor through comparison with historical and concurrent controls.
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