181 - Improving Influenza Immunization Rates in Patients with Chronic Medical Conditions

Poster Number: 181
Publication Number: 181.142

Snezana Nena Osorio, Weill Cornell Medicine, New York, NY, United States; Karyn Jonas, Weill Cornell Medicine, New York, NY, United States; Hilary Carlson, Weill Cornell Medicine, New York, NY, United States; Maria Reyes, Weill Cornell Medical Center, New York, NY, United States; Robbyn Sockolow, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States

Background: A review of literature suggests that children with certain chronic medical conditions such as liver or kidney transplant recipients are at higher risk for influenza-related complications than the general pediatric population. Although influenza immunization is recommended for children with high-risk medical conditions, many of such children do not receive influenza vaccine. Furthermore, at our site not all subspecialty clinics offer influenza vaccination.

Objective: To improve influenza immunization rate for patients with chronic medical conditions seen in subspecialty clinics from October 2021 through March 2022 from 60 to 90%.  

Design/Methods: We used the model for improvement and planned, sequential experimentation to test interventions derived from change ideas (Figure 1, Driver Diagram) for patients with chronic medical conditions such as primary diabetes, post liver and kidney transplant, asthma etc. ages 6 month to 21years seen in subspecialty clinics affiliated with an academic tertiary medical center. Documentation of influenza vaccine administration (outcome), completion of medical staff education regarding affirmative approach to obtaining oral vaccination consent (process) and rates of vaccine hesitancy (balancing) were tracked to monitor the effect of interventions. Run charts were utilized to display and analyze the data. Run chart rules were applied to detect signal of change.

Results: In this sample of 242 patients, influenza immunizations improved from 69% to 80% (Figure 2). All members of medical staff completed education on how to use the affirmative approach to obtaining vaccine consent.  Only 6% of patients refused influenza vaccine (n = 15), while 2% reported getting vaccine elsewhere (n = 6). However, 14% of patient had no documentation of influenza vaccination (n = 35). In this sample of 242 patients, influenza immunizations improved from 69% to 80% (Figure 2). All members of medical staff completed education on how to use the affirmative approach to obtaining vaccine consent.  Only 6% of patients refused influenza vaccine (n = 15), while 2% reported getting vaccine elsewhere (n = 6). However, 14% of patient had no documentation of influenza vaccination (n = 35).Conclusion(s): We successfully increased influenza vaccination rates for children with chronic medical conditions. The most impactful interventions included the use of affirmative approach to obtaining oral consent, EMR-based best practice alert, electronic messaging via personal health record and/or phone call reminders. Next steps include using dedicated nurse vaccinator and  co-offering Covid19 vaccination.
Figure 1. Key Driver DiagramImproving influenza immunization for patients with chronic medical conditions was chosen as target for improvement (left). We brainstormed primary and secondary drivers (center) and designed interventions using change ideas (right)
Figure 2. Run ChartRun chart showing an increase in influenza immunization rate from 69% to 80%. Solid Line boxes indicate interventions.