Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge.
Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge.
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DOI：
10.1001/jamanetworkopen.2021.17809
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发表时间：
2021-07-01
影响因子：
13.8
通讯作者：
Jernigan S
中科院分区：
文献类型：
--
作者：
Orenstein EW;ElSayed-Ali O;Kandaswamy S;Masterson E;Blanco R;Shah P;Lantis P;Kolwaite A;Dawson TE;Ray E;Bryant C;Iyer S;Shane AL;Jernigan S
临床决策支持（CDS）策略与符合条件的住院儿童出院前流感疫苗接种率的提高有关吗？在这项质量改进研究中，与同期对照和历史对照相比，在符合条件的患者的入院顺序中，使用假定策略提供疫苗的护理脚本的默认检查流感疫苗顺序与住院儿童接受流感疫苗的几率显著增加相关。这项研究表明，以用户为中心的CDS策略可能会提高弱势住院儿童的疫苗接种率。住院儿童患流感相关并发症的风险增加，但这一群体的流感疫苗覆盖率仍然很低。在COVID-19大流行期间，在所有卫生保健就诊期间为弱势儿童接种疫苗的循证战略尤为重要。设计和评估临床决策支持（CDS）策略，以提高住院儿童在出院前接种季节性流感疫苗的比例。这项质量改进研究是在符合季节性流感疫苗接种条件的儿童中进行的，这些儿童在三级儿科卫生系统住院，该系统每年在3家医院为50多万患者提供护理。该研究采用了从对照到干预的顺序交叉设计，并比较了干预组（2019-2020赛季使用干预顺序集）、同期对照组（2019-2020赛季不使用干预顺序集）和历史对照组（2018-2019赛季使用2019-2020赛季进行干预的顺序集）的住院情况。CDS干预是通过以用户为中心的设计过程开发的，包括(1)将默认的流感疫苗订单放入符合条件的患者的入院订单集中，(2)使用假定策略提供疫苗的脚本，以及(3)及时教育临床医生解决流感订单组的疫苗资格问题，并提供更多参考资料的链接。该干预措施在2019-2020年流感季节期间逐步推出。出院前接种一种或多种流感疫苗的合格住院比例。在17 740例住院患者中（9295例男孩[52%]），平均（SD）年龄为8.0（6.0）岁，患者以黑人（n = 8943例[50%]）或白人（n = 7559例[43%]）为主，多数有公共保险（n = 11 274例[64%]）。在2019-2020年流感季节，有10997例住院治疗符合接种流感疫苗的条件。其中干预组5449例（50%），同期对照组5548例（50%）。2018-2019年有6743例符合条件的住院治疗作为历史对照。干预组的疫苗接种率为31% (n = 1676)，同期对照组为19% (n = 1051)，历史对照组为14% (n = 912) （P < 0.001）。在校正分析中，干预组接种流感疫苗的几率比历史对照组高3.25倍（95% CI, 2.94-3.59），同期对照组高1.28倍（95% CI, 1.15-1.42）。这项质量改进研究表明，以用户为中心的CDS可能与住院儿童流感疫苗接种率的显著提高有关。逐步实施CDS干预是一种实用的方法，通过与历史对照和并发对照的比较，可以提高质量改进的严谨性。本质量改进研究评估临床决策支持策略，以增加住院儿童在出院前接种季节性流感疫苗的比例。
Is a clinical decision support (CDS) strategy associated with improved influenza vaccination rates before discharge among eligible hospitalized children? In this quality improvement study, the combinination of a default-checked influenza vaccine order in admission order sets for eligible patients with a nursing script using a presumptive strategy to offer the vaccine was associated with significantly higher odds of the hospitalized child receiving the influenza vaccine compared with concurrent and historical controls. This study suggests that a user-centered CDS strategy may improve vaccination rates among vulnerable, hospitalized children. 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. 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. 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). 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. Proportion of eligible hospitalizations in which 1 or more influenza vaccines were administered prior to discharge. 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. 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. This quality improvement study evaluates a clinical decision support strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge.
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影响因子：
2.4
作者：
Feudtner C;Feinstein JA;Zhong W;Hall M;Dai D
通讯作者：
Dai D
DOI：
10.1073/pnas.1103170108
发表时间：
2011-06-28
影响因子：
11.1
作者：
Milkman, Katherine L.;Beshears, John;Madrian, Brigitte C.
通讯作者：
Madrian, Brigitte C.
影响因子：
12.7
作者：
Opel, Douglas J.;Mangione-Smith, Rita;Taylor, James A.
通讯作者：
Taylor, James A.
影响因子：
5.1
作者：
Birmingham, Eileen;Catallozzi, Marina;Stockwell, Melissa S.
通讯作者：
Stockwell, Melissa S.
影响因子：
8
作者：
Fiks, Alexander G.;Hunter, Kenya F.;Alessandrini, Evaline A.
通讯作者：
Alessandrini, Evaline A.