Improving Influenza Vaccine Uptake in Acute Care Settings

Healthcare encounters are an important opportunity to provide health maintenance interventions. The National Vaccine Advisory Committee recommends indicated vaccines be administered at every healthcare encounter, including acute care visits. Despite this recommendation, influenza vaccine rates in children are below 50 percent. This rate is concerning, particularly for children who are hospitalized, because they are more likely to have conditions that put them at higher risk for complications from influenza. Clinical decision support (CDS) strategies may provide a technology solution to improve vaccine uptake in pediatric acute care settings. CDS provides clinicians, staff, and others with knowledge and patient-specific information at appropriate times in the clinical workflow for informed decision making and action to support improved quality of care and health outcomes.

Building on preliminary work that developed a CDS rule to identify hospitalized patients eligible for influenza vaccine, an Emory University research team will develop a CDS system and test its usability, implementation, and impact on influenza vaccine uptake among children at three hospitals within the Children’s Healthcare Atlanta health system.

The specific aims of this research are as follows:

• Design CDS to promote influenza vaccine uptake in pediatric acute care settings with a user-centered design approach. 
• Evaluate implementation of effectiveness using the RE-AIM framework. 

The first phase of this study will involve user-centered design to develop the CDS. User and task analysis with frontline ordering clinicians, nurses, pharmacists, family advocates, and operational leaders will provide insights on the influenza vaccine administration process. These insights will inform design of CDS prototypes, which will then undergo iterative usability testing and improvements until a final CDS strategy is developed.

In the second phase of this study, the CDS strategy will be implemented in the three hospitals, and the team will evaluate the implementation effectiveness guided by the RE-AIM Framework. A variety of methods, including electronic health record queries, surveys, and observations, will assess the reach of the CDS strategy, its efficacy to improve uptake of influenza vaccine, adoption by clinicians and organizational leaders, implementation fidelity, and the costs of maintaining the strategy. Data and findings from this study will provide an example of a CDS strategy for improving uptake of influenza vaccine in pediatric acute care settings, and provide implementation guidance for health systems. Considering many health maintenance interventions share key elements of promoting vaccine uptake-–including the need to identify eligible children, an order to perform the intervention, nursing involvement, and documentation of the intervention that can be shared with an outpatient team-–the findings from this study can serve as a CDS model for other health maintenance interventions in acute care settings.