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Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge.
JAMA Netw Open. 2021 07 01; 4(7):e2117809.JN

Abstract

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.

Authors+Show Affiliations

Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Washington University in St Louis, St Louis, Missouri.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Infectious Diseases, Children's Healthcare of Atlanta, Atlanta, Georgia.Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Division of Nephrology, Children's Healthcare of Atlanta, Atlanta, Georgia.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

34292335

Citation

Orenstein, Evan W., et al. "Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge." JAMA Network Open, vol. 4, no. 7, 2021, pp. e2117809.
Orenstein EW, ElSayed-Ali O, Kandaswamy S, et al. Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge. JAMA Netw Open. 2021;4(7):e2117809.
Orenstein, E. W., ElSayed-Ali, O., Kandaswamy, S., Masterson, E., Blanco, R., Shah, P., Lantis, P., Kolwaite, A., Dawson, T. E., Ray, E., Bryant, C., Iyer, S., Shane, A. L., & Jernigan, S. (2021). Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge. JAMA Network Open, 4(7), e2117809. https://doi.org/10.1001/jamanetworkopen.2021.17809
Orenstein EW, et al. Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge. JAMA Netw Open. 2021 07 1;4(7):e2117809. PubMed PMID: 34292335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge. AU - Orenstein,Evan W, AU - ElSayed-Ali,Omar, AU - Kandaswamy,Swaminathan, AU - Masterson,Erin, AU - Blanco,Reena, AU - Shah,Pareen, AU - Lantis,Patricia, AU - Kolwaite,Amy, AU - Dawson,Thomas E, AU - Ray,Edwin, AU - Bryant,Christy, AU - Iyer,Srikant, AU - Shane,Andi L, AU - Jernigan,Stephanie, Y1 - 2021/07/01/ PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/8/6/medline SP - e2117809 EP - e2117809 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 7 N2 - 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. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/34292335/Evaluation_of_a_Clinical_Decision_Support_Strategy_to_Increase_Seasonal_Influenza_Vaccination_Among_Hospitalized_Children_Before_Inpatient_Discharge. L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2021.17809 DB - PRIME DP - Unbound Medicine ER -