Geographic Evaluation of Georgia Vaccination Disparity Among Laboratory-Confirmed Influenza Cases in a Children’s Hospital

Background: Vaccination coverage among children aged ≤18 years in Georgia remains one of the lowest in the nation with 39.3% coverage. During the 2018–2019 influenza season, the CDC reported 142 pediatric deaths, 3 of which occurred in Georgia. In a time of increasing complexity of immunization schedules, increase severity with a high level of flu-related deaths and hospitalization, it is important to understand localized factors that contribute to decrease influenza immunization and increased flu-related hospital visits among children. Methods: Data include electronic medical record chart review of 5,827 laboratory confirmed Children’s Healthcare of Atlanta visitor cases from October 1, 2016, to September 24, 2019. System-wide county level data included 3 pediatric hospitals, 5 primary care facilities, 8 urgent care facilities, and 2 outpatient clinics. Characteristics associated with disparities in vaccine were explored using univariate and multiple regressions analysis. Of those children with a primary care physician (PCP), 30% had flu vaccinations, whereas only 16.5% of those without a PCP had been vaccinated (P ≤ .00001). There was a positive relationship between increased county influenza rate and percentage of children in county who were preschoolers <5 years old (r = 0.93; P ≤ .05). Moreover, 78% of children who received the flu vaccine ≤ 2 weeks prior to a confirmed flu diagnosis got the flu during peak flu periods (r = 0.29; P ≤ .05). Predictors of increased flu rate per 1,000 children were associated with flu vaccines given ≤2 weeks before a lab confirmed flu diagnosis (P ≤ .02). Children in counties that had a higher rate of flu during the peak period also had an overall higher rate of flu (P ≤ .005). The higher the percentage of children who got flu during peak flu period, the lower the vaccination rate for the county (P ≤ .001). The percentage of children ≤18 years old with no health insurance was associated with lower vaccination rates in the county (P ≤ .004). There appears to be a positive relationship between receiving flu vaccine 2 weeks prior to lab-confirmed flu diagnosis and onset of illness during the peak flu periods. Missed opportunities to obtain a flu vaccine by a PCP were associated with increased flu-related hospital visits and lower vaccination rates. Results may support predischarge hospital vaccinations and the promotion of flu vaccination education. Pediatric research is needed to facilitate localized PCP vaccination or predischarge hospital vaccinations prior to peak flu periods when hospital-related flu visits increase.Funding: NoneDisclosures: None

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Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China

BMJ Global Health ◽

10.1136/bmjgh-2020-002792 ◽

2020 ◽

Vol 5 (8) ◽

pp. e002792 ◽

Cited By ~ 1

Author(s):

Jin Xu ◽

Timothy Powell-Jackson ◽

Anne Mills

Keyword(s):

Primary Care ◽

Regression Analysis ◽

Impact Evaluation ◽

Claims Data ◽

Northern China ◽

Difference In Differences ◽

Pilot Scheme ◽

Care Facilities ◽

Cooperative Medical Scheme ◽

Hospital Visits

IntroductionThis paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.MethodsWe applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014.ResultsThe gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011).ConclusionsThis first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.

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Increasing Pneumococcal Vaccination Rates Among Residents of Long-Term–Care Facilities: Provider-Based Improvement Strategies Implemented by Peer-Review Organizations in Four Western States

Infection Control and Hospital Epidemiology ◽

10.1086/501723 ◽

2000 ◽

Vol 21 (11) ◽

pp. 705-710 ◽

Cited By ~ 22

Author(s):

Kurt B. Stevenson ◽

John W. McMahon ◽

Jan Harris ◽

J. Richard Hillman ◽

Steven D. Helgerson

Keyword(s):

Long Term Care ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Term Care ◽

Improvement Project ◽

Vaccination Rates ◽

Standing Order ◽

Care Facilities ◽

Collaborative Efforts

AbstractObjective:To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.Design:Prospective, before-after quality improvement project.Setting:133 LTCFs in Alaska, Idaho, Montana, and Wyoming.Patients:All residents of participating LTCFs.Methods:Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.Results:133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.Conclusions:Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.

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1402. Smart Technology and Education for Smart Protection against the Flu: Impact of a Multifaceted Quality Improvement (QI) Intervention on Influenza Vaccination Rates in Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1584 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S709-S709

Author(s):

Ashlesha Kaushik ◽

Kristen Beal ◽

Sandeep Gupta ◽

Richard Malley

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Tertiary Care ◽

Vaccination Rate ◽

Urgent Care ◽

Outpatient Clinics ◽

Intervention Period ◽

Health Maintenance ◽

Vaccination Rates ◽

Influenza Immunization

Abstract Background Low pediatric influenza vaccination rates are a public health challenge. It is imperative that innovative measures to promote influenza immunization are studied. Methods Aim: To study impact of a multifaceted QI intervention on influenza vaccination rates in children evaluated at outpatient clinics, urgent care (UC) and emergency departments (ED) at UnityPoint Health tertiary care centers (UPH) across Northwestern (NW) and Northcentral (NC) Iowa (IA). Patients aged 6 months-18 years evaluated at UPH in NW and NC IA (encompassing 5 outpatient clinics, 2 UC, 2 ED) were included. A multifaceted QI intervention was implemented on 9/1/2018 consisting of all of the following concomitantly: 1. Patient/family education: Posters about flu vaccination displayed at entrance, in waiting rooms and patient rooms throughout the clinics, UC, ED as well as patient/family handouts emphasizing importance of influenza immunization. 2. Information Technology: “Health maintenance” reminder in outpatient electronic medical record (EMR- EPIC) that appears as soon as a patient’s chart is accessed to remind nurses/providers that influenza vaccine is due. 3. Provider Education flyers at study sites about debunking flu myths. We compared pre-intervention period (P1, 09/01/2017– 05/31/2018) with intervention period (P2, 09/01/2018 – 05/31/2019) for influenza vaccination rates. Results A total of 10050 and 9889 patients were evaluated during P1 and P2 respectively. Influenza vaccination rate increased significantly from 56.1% (5642) in P1 to 73.3% (7252) in P2 (p< 0.0001). Patients were 1.43 times more likely to get vaccinated during P2 than P1 (95% CI= 1.32-1.46). Regionally during P2, influenza vaccination rate was higher than the national (62.6%; p< 0.0001) and Iowa state averages (65.8%; p< 0.0001) respectively. Proportion of children aged < 9 years receiving second dose of influenza vaccine increased from 43% to 69% (p< 0.001). Influenza vaccination rates among children aged 6-36 months increased significantly [40% (1078/2671) in P1 to 47.2% (1287/2723) in P2; p< 0.01]. Conclusion With the combined educational and technologic intervention, pediatric influenza vaccination rates increased significantly across NW and NC IA, including proportion of patients receiving second dose of the vaccine. Disclosures Richard Malley, MD, Merck (Consultant)

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Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review

Vaccines ◽

10.3390/vaccines9111330 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1330

Author(s):

Francesca Rosamilia ◽

Giovanni Noberasco ◽

Dario Olobardi ◽

Andrea Orsi ◽

Giancarlo Icardi ◽

...

Keyword(s):

Systematic Review ◽

Vaccine Coverage ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Vaccination Rates ◽

Increased Risk ◽

Flu Vaccine ◽

Vaccination Campaigns ◽

Low Coverage ◽

Current Guidelines

Systemic sclerosis (scleroderma, SSc) is an autoimmune connective tissue disease characterized by excessive production of collagen and multiorgan involvement. Scleroderma patients are at increased risk of influenza complications and pneumonia; thus, vaccinations are recommended. This systematic review evaluated the influenza and pneumococcus vaccination coverage for SSc patients. We included all studies from Pubmed reporting on influenza and pneumococcal vaccination rate in Scleroderma patients up to May 2021. The 14 studies thus selected identified a suboptimal vaccination rate in autoimmune and SSc patients, ranging from 28 to 59% for the flu vaccine, and from 11 to 58% for the pneumo vaccine in absence of specific vaccination campaigns, variously considering also other variables such as age, gender, vaccination settings, and possible vaccination campaigns. We also considered the reasons for low coverage and the approaches that might increase the vaccination rates. A lack of knowledge about the importance of vaccination in these patients and their doctors underlined the need to increase the awareness for vaccination in this patients’ category. Current guidelines recommend vaccination in elderly people and people affected by particular conditions that widely overlap with SSc, yet autoimmune diseases are not always clearly mentioned. Improving this suboptimal vaccination rate with clear guidelines is crucial for SSc patients and for clinicians to immunize these categories based principally on the pathology, prior to the age. Recommendations by the immunologist and the direct link to the vaccine providers can highly improve the vaccine coverage.

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