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Identifying Practices to Promote Inpatient Adolescent and Influenza Vaccine Delivery
Alexandra J Mihalek1, Matt Hall2, Christopher J Russell3,4
1Hospitalist Division, Children's Hospital of Orange County, Orange, California.
Insights
Hospital immunization practices significantly impact influenza vaccine delivery in children. Specific strategies like visual prompts and nurse-led ordering show the most promise for improving vaccination rates.
Area of Science:
- Pediatric Health
- Vaccinology
- Healthcare Quality Improvement
Background:
- Hospitalized children often have suboptimal immunization coverage.
- Assessing hospital immunization practices is crucial for improving vaccine delivery.
Purpose of the Study:
- To evaluate the association between hospital immunization practices and the delivery of tetanus, diphtheria, acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccines.
- To identify specific hospital practices that enhance vaccine delivery rates among hospitalized children.
Main Methods:
- An electronic survey was distributed to hospitals within the Pediatric Health Information System (PHIS) network.
- Vaccine delivery rates for adolescent and influenza vaccines were calculated using PHIS database data from 2018.
- Generalized linear mixed-effects modeling was used for risk adjustment and to compare survey responses with vaccine delivery rates.
Main Results:
- Twenty-nine hospitals (57% response rate) completed the survey.
- The number of hospital practices was significantly associated with influenza vaccine delivery (P = .02).
- Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were linked to increased influenza vaccine delivery; nurse/pharmacist ordering had the largest effect. No practices correlated with Tdap delivery.
Conclusions:
- Specific hospital immunization practices, particularly those involving nursing or pharmacy staff ordering, can improve influenza vaccine delivery.
- Further research is necessary to develop effective strategies for increasing inpatient adolescent immunization rates.
Objectives:
Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery.
Methods:
An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery.
Results:
Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery.
Conclusions:
The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.
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