506 - Improving Pneumococcal Vaccination Rate in High-Risk Pediatric Patients

Poster Number: 506
Publication Number: 506.325

Lauren Lipshutz, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Crystin Liboma, Nemours Children's Hospital, Middletown, DE, United States; Zhongcui Gao, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Jonathan M. Miller, Nemours Children's Health, Wilmington, DE, United States; Anthony W. Gannon, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States

Background: The CDC recommends use of the 23-Valent Pneumococcal Polysaccharide (PPSV23) Vaccine in populations of pediatric patients at high risk for pneumococcal disease, including those with cochlear implants, diabetes mellitus, or sickle cell disease. However, there are many barriers to accurate tracking and administration of this vaccine and overall adherence is suboptimal.

Objective: The objective of this QI project is to develop reliable tools for measuring PPSV23 vaccination, identify barriers to administration of PPSV23 and develop strategies to increase the vaccination rate by 5% within 1 year in a population of high-risk pediatric patients.

Design/Methods: Children between 2 and 18 years of age with cochlear implants, diabetes mellitus, and sickle cell disease seen at Nemours Children’s Health Delaware (NCHD) and its affiliated pediatric clinically integrated network were entered into a registry. Electronic tools within the registry were used to identify receipt of the vaccine. Focused needs assessments were completed and tools were created to provide educational materials and reliable methods for medical staff and providers, automated alerts within the electronic medical record, and written notifications for eligible families. The intervention was applied between August 1, 2020 and July 31, 2021. The primary outcome measure was PPSV23 vaccination rate among eligible populations. The primary process measure was the rate of PPSV23 vaccine administration during relevant clinic visits.

Results: 1,069 eligible patients had clinic visits at NCHD during the intervention period and the rate of vaccination increased significantly compared to the baseline (66.7% vs 56.2%, p < 0.001).  Children with diabetes demonstrated the greatest improvement in rate of vaccination (62.9% vs 48.1%, p < 0.001), while children with cochlear implants (42.1% vs 34.2%, p=0.31) and sickle cell disease demonstrated less change (80.6% vs 81.4%, p=0.816).Conclusion(s): This intervention resulted in significant increases in PPSV23 vaccination rates across this high-risk group, most notably in children with diabetes. This success was noted despite the impact of the COVID-19 pandemic. These findings demonstrate the potential for quality improvement that may be achieved through collaboration in a pediatric clinically integrated network. This approach could be applied to other QI initiatives, such as immunizations, health screens, and well visits.