Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge

Autor: Srikant Iyer, Pareen Shah, Amy Kolwaite, Patricia Lantis, Omar Elsayed-Ali, Christy Bryant, Erin Masterson, Andi L. Shane, Edwin Ray, Thomas E. Dawson, Stephanie Jernigan, Reena Blanco, Evan W. Orenstein, Swaminathan Kandaswamy
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: Key Points Question Is a clinical decision support (CDS) strategy associated with improved influenza vaccination rates before discharge among eligible hospitalized children? Findings In this quality improvement study, the combinination of a default-checked influenza vaccine order in admission order sets for eligible patients with a nursing script using a presumptive strategy to offer the vaccine was associated with significantly higher odds of the hospitalized child receiving the influenza vaccine compared with concurrent and historical controls. Meaning This study suggests that a user-centered CDS strategy may improve vaccination rates among vulnerable, hospitalized children.
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
This quality improvement study evaluates a clinical decision support strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge.
Databáze: OpenAIRE
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