Quality of Health Care for Children and Adolescents: A Chartbook

Contains 40 charts and analyses that represent the current state of pediatric health care. Provides practical guidance and recommendations for policymakers, health care professionals, and patient advocates

Promoting Adherence to Influenza Vaccination Recommendations in Pediatric Practice.

OBJECTIVES: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence. METHODS: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children\u27s health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], web-based training [WBT], or CCDSS and WBT [BOTH]). RESULTS: During the study, 55.8% of children and adolescents received influenza vaccination, which improved modestly during the study period compared with the prior influenza season ( P = .009). Actual adherence to recommendations, including dosing, timeliness, and avoidance of missed opportunities, was 46.4% of patients cared for by the PRACTICE. The WBT was most effective in promoting adherence with vaccination recommendations with an estimated average odds ratio = 1.26, P \u3c .05, to compare between preintervention and intervention periods. Over the influenza season, there was a significantly increasing trend in odds ratio in the WBT arm ( P \u3c .05). Encouraging process improvements and providing longitudinal feedback on monthly rate of vaccination sparked some practice changes but limited impact on outcomes. CONCLUSIONS: Web-based training at the start of influenza season with monthly reports of adherence can improve correct dose and timing of influenza vaccination with modest impact on overall vaccination rate

Cost effectiveness analysis of Year 2 of an elementary school-located influenza vaccination program-Results from a randomized controlled trial.

BackgroundSchool-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season).MethodsWe performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; Year 2 n = 9,145 children) with standard-of-care (no SLV-I) in control schools (Year 1 n = 4,534 (10 schools); Year 2 n = 4,796 children (11 schools)). We estimated the cost-per-vaccinated child, by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools).ResultsIn Years 1 and 2, respectively, the effectiveness measure (proportion of children vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7 % and 40.4 %) than control schools. In year 2, the cost-per-vaccinated child excluding vaccine purchase ($59.88 in 2010 US$) consisted of three component costs: (A) the school costs ($8.25); (B) the project coordination costs ($32.33); and (C) the vendor costs excluding vaccine purchase ($16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated child, excluding vaccine purchase, was$59.73 (Year 1) and $59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing influenza vaccination in medical practices ($39.54). However, taking indirect costs (e.g., averted parental costs to visit medical practices) into account, vaccination was less costly in SLV-I ($23.96 in Year 1,$24.07 in Year 2) than in medical practices.ConclusionsOur two-year trial's findings reinforced the evidence to support SLV-I as a potentially favorable system to increase childhood influenza vaccination rates in a cost-efficient way. Increased efficiencies in SLV-I are needed for a sustainable and scalable SLV-I program

Pediatric Vaccination System (I-Vacci)

Web based pediatrics vaccination system (I-VACCI) is a web based system that is developed to assist health care professional and public health administrator in managing the vaccination for pediatrics. The web based system, I-VACCI, will record vaccination records for Malaysian‟s pediatrics. The concept of a web-based pediatrics vaccination system is, it stores, records and maintains data of vaccination record for Malaysian pediatrics. I-VACCI helps health care professional to manage better vaccination data such as the types of vaccination given to the pediatrics according to the schedule, generate factual data on the progress of immunization in the country and manage better its operation and optimize its cost. I-VACCI is developed by using Hypertext Preprocessor (PHP) and MySQL as the database. PHP is used because it is widely used and powerful language. IVACCI will be accessed via Internet. Finally, we can conclude that the web based pediatrics vaccination system (I-VACCI) will be an advantage to manage the vaccination that given to the pediatrics and it benefits to various parties

Barriers and facilitators to HPV vaccination in primary care practices: A mixed methods study using the Consolidated Framework for Implementation Research

Abstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation

Influenza and Asthma: An Evidenced-Based Approach to Increasing Influenza Vaccinations Among Asthmatic Children

Asthma is a complex inflammatory process affecting over 6 million American children. Influenza is a seasonal viral respiratory illness that rapidly spreads via droplet contact. The most effective means of preventing influenza is with an annual influenza vaccination. Pediatric experts agree that asthmatic children should be vaccinated against influenza. Despite this consensus, vaccination remains low. A local pediatric practice is participating in a quality improvement project. One program component focuses on engaging primary care practices in an initiative to increase influenza vaccines among asthmatic children. Although improved vaccination is a goal, the program has not provided any clear strategies for increasing vaccination rates. To facilitate the goal, a retrospective chart review was conducted, gathering recent practice data on influenza. Descriptive and correlational statistics were analyzed. A significant correlation was found between insurance type and vaccination status. After data collection, a literature review was conducted with the purpose of developing an evidenced-based approach to increasing vaccination rates among asthmatic children. Based upon results from the literature, fourteen recommendations were made and categorized according to level of evidence into strong, moderate, and weak recommendations. The information was compiled and presented in educational sessions to physicians and staff of the local practice

Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives

Reviews the structure, prevalence, measurement issues, perception, and impact of current quality incentive programs, and discusses how much and under what circumstances they will improve quality of care. Includes descriptions of select programs

Assessing and Improving Pediatric Nurses\u27 Documentation of Childhood Immunization Status Using the Electronic Health Record

BACKGROUND: Adherence to the standardized childhood immunization schedule put forth by the American Academy of Pediatrics is the gold standard for decreasing vaccine-preventable disease morbidity. The first step to improving adherence with the recommended immunization schedule is identifying children who are under-immunized. The inpatient setting offers an opportunity to screen pediatric patients for immunization status. A survey was administered to nurses working on an inpatient pediatric unit to gauge nurse self-report of Cerner™ Electronic Health Record (EHR) use for immunization documentation, their perceptions regarding EHR ease of use for documenting pediatric immunization status, attitudes towards documenting immunization status, and perceived implications for nursing care. METHODS: The Define, Measure, Analyze, Implement, Control (DMAIC) framework was utilized for this quality improvement project. The pre-intervention survey was administered anonymously to six nurses working on the unit. The results revealed a discrepancy between self-reported assessment practices and self-reported documentation practices concerning patient immunization status. Based on these findings, the intervention was implemented. A post-survey was conducted to re-examine nurse documentation practices and attitudes towards the change. INTERVENTION: Based on current evidence supporting the importance of nurse-driven screening in identifying patients at risk for vaccine-preventable diseases and the survey results revealing that some pediatric unit nurses do not always document childhood immunization status upon admission, the decision was made to change the previously optional question regarding immunization status in the EHR’s Admission History PowerForm™ to a required field. The quality improvement intervention was implemented in collaboration with pediatric unit leadership and the facility’s Nursing Informatics Committee. A Situation, Background, Assessment, Recommendation (SBAR) report was disseminated to substantiate the change. RESULTS: Missing data from the post-survey limited the evaluation of nurse documentation practices and attitudes towards the newly required EHR field following the intervention. There was one respondent to the post-survey, who reported documenting immunization status during admission 100% of the time and provided qualitative feedback supporting the change. Unit leadership reported that the change was accepted by staff. CONCLUSIONS: This quality improvement project was a useful first step towards improving nurse-driven screening practices in the pediatric unit. Identification of patients at risk for vaccine-preventable disease is the foundation required to increase immunization rates on a population health level. However, to sustain and progress towards improving immunization status screening and ultimately increasing opportunities for children to be brought up to date on vaccinations, further steps will be required on behalf of unit leadership and staff. Those steps should include chart audits to monitor compliance with required EHR fields, the development of a written policy for immunization documentation, and efforts to increase the availability and administration frequency of vaccines for under-immunized children admitted to the unit

Implications of a national immunization registry an alliance to win the race for the future care and accuracy of pediatric immunization

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries