178 - A Focus on Influenza Vaccinations for Pediatric Asthma Patients During a Pandemic

Poster Number: 178
Publication Number: 178.142

Lisa Bartucca, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Dana Greene, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Snezana Nena Osorio, Weill Cornell Medicine, New York, NY, United States; Erika Abramson, Weill Cornell Medicine, New York, NY, United States; Noemi Charnow, Weill Cornell Medicine, Scarsdale, NY, United States

Background: In the pediatric population, up to 80% of influenza-associated deaths have occurred in unvaccinated children 6 months and older, with a higher incidence of hospitalization and complications in asthmatic patients. Lower income, non-white, and urban populations report lower vaccination rates. Given these factors, particularly during the COVID-19 pandemic, influenza vaccination among pediatric asthmatic patients is especially important.

Objective: To increase the influenza vaccination rate of all eligible asthmatic patients aged 6 months –18 years from 46% to 60% during the influenza season by the end of January 2022.

Design/Methods: This ongoing 2-year, resident-led quality improvement (QI) project has been conducted at a community-based clinic affiliated with a tertiary medical center using the model for improvement. The following measures were used to monitor the effect of interventions including % of asthmatic patients who received the influenza vaccine (outcome), % of eligible patients who received the influenza vaccine during in-person resident and/or nursing visits (process) and no decrease in annual well visit rates (balancing).  Multiple interventions were designed using tertiary drivers (Figure 1) and tested via PDSA cycles. A retrospective chart review was used to acquire vaccination rates for the following seasons 2019/20, 2020/21 and 2021/22. The data was analyzed using run charts and run chart rules were applied to detect signal of change.

Results: Immunization rates for the past two influenza seasons (2019/20 and 2020/21) were similar (49% and 48% respectively). To date median immunization rate is 34% (Figure 2). Of the patients who received the influenza vaccine, 83% were during in-person resident visits and 17% were during nursing visits. The number of the annual well-child visits (balancing measure) increased during the study period (Figure 3). This clinic site demonstrated the highest overall influenza vaccination rate when compared to 7 other similar in-network facilities. Conclusion(s): Despite the COVID-19 pandemic, this resident-led QI team succeeded in maintaining influenza immunization rates and reached the highest immunization rate within the clinic system.  The most impactful interventions were: team engagement, creation of RN visits, and pre-visit planning with targeted patient recall. Next steps include further testing of a newly created electronic targeted recall for asthmatic patients through the EMR and addressing vaccine hesitancy with the use of affirmative language.
Figure 1: Key Driver DiagramInterventions were designed as tertiary drivers and tested via PDSA cycles.
Figure 2: Eligible Asthmatic Patients Vaccinated During 2019 – Current 2021 Influenza SeasonsInfluenza vaccination rates of eligible asthmatic patients were similar during 2019/2020 and 2020/2021 seasons. To date median immunization rate is 34%.