The Influence of Age on the Likelihood of Catheter-Free Fistula Use in Hemodialysis Patients

Background: Clinical practice guidelines recommend arteriovenous fistulas as the preferred form of vascular access for hemodialysis. However, some studies have suggested that older age is associated with poorer fistula outcomes. Objective: We assessed the impact of age on the outcomes of fistula creation and access-related procedures. Design: This was a prospective cohort study using data collected as part of the Dialysis Measurement Analysis and Reporting (DMAR) system. Setting: Participating Canadian dialysis programs, including Southern Alberta Renal Program, Manitoba Renal Program, Sunnybrook Health Sciences Centre (Toronto, Ontario), London Health Sciences Centre (London, Ontario), and The Ottawa Hospital (Ottawa, Ontario). Patients: Incident hemodialysis patients aged 18 years and older who started dialysis between January 1, 2004, and May 31, 2012. Measurements: The primary outcome was the proportion of all first fistula attempts that resulted in catheter-free fistula use, defined as independent use of a fistula for hemodialysis (ie, no catheter in place). Secondary outcomes included the time to catheter-free fistula use among patients with a fistula creation attempt, total number of days of catheter-free fistula use, and the proportion of a patient’s hemodialysis career spent with an independently functioning fistula (ie, catheter-free fistula use). Methods: We compared patient characteristics by age group, using t tests or Wilcoxon rank sum tests, and chi-square or Fisher exact tests, as appropriate. Logistic and fractional logistic regression were used to estimate the odds of achieving catheter-free fistula use by age group and the proportion of dialysis time spent catheter-free, respectively. Results: A total of 1091 patients met our inclusion criteria (567 age ≥ 65; 524 age < 65). Only 57% of first fistula attempts resulted in catheter-free fistula use irrespective of age (adjusted odds ratio [OR]≥65vs<65: 1.01; P = .93). The median time from hemodialysis start to catheter-free use of the first fistula did not differ by age when grouped into fistulas attempted pre- and post-dialysis initiation. The adjusted rates of access-related procedures were comparable (incidence rate ratio [IRR]≥65vs<65: 0.95; P = .32). The median percentage of follow-up time spent catheter-free was similar and low in patients who attempted fistulas (<65 years: 19% vs ≥65 years: 21%; P = .85). Limitations: The relatively short follow-up time may have underestimated the benefits of fistula creation and the observational study design precludes inferences about causality. Conclusions: In our study, older patients who underwent a fistula attempt were just as likely as younger patients to achieve catheter-free fistula use, within a similar time frame, and while requiring a similar number of access procedures. However, the minority of dialysis time was spent catheter-free.

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Library Impact Research Report: Understanding and Communicating Research Impact: The Needs of STEM and Health Sciences Faculty and Postdoctoral Researchers

10.29242/report.uwashington2021 ◽

2021 ◽

Author(s):

Negeen Aghassibake ◽

Lynly Beard ◽

Jackie Belanger ◽

Diana Louden ◽

Robin Chin Roemer ◽

...

Keyword(s):

Research Impact ◽

Health Sciences ◽

Future Research ◽

Research Report ◽

Library Impact ◽

The University ◽

Postdoctoral Researchers ◽

Impact Framework ◽

The Impact

As part of ARL’s Research Library Impact Framework initiative, the University of Washington (UW) Libraries explored UW faculty and postdoctoral researcher needs for understanding and communicating the impact of their work, with a focus on researchers in science, technology, engineering, and math (STEM) and health sciences fields. The project was designed to understand the challenges researchers face in this area, identify how participants in these fields define and measure impact, and explore their priorities for research-impact support. The project team conducted a survey and follow-up interviews to investigate these questions. This research report presents the project team’s methodology, findings, and recommendations for future research.

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The Prevalence of Persistent Intradialytic Hypertension in a Hemodialysis Population with Extended Follow-Up

The International Journal of Artificial Organs ◽

10.1177/039139881203501201 ◽

2012 ◽

Vol 35 (12) ◽

pp. 1031-1038 ◽

Cited By ~ 10

Author(s):

Peter N. Van Buren ◽

Catherine Kim ◽

Robert D. Toto ◽

Jula K. Inrig

Keyword(s):

Blood Pressure ◽

Linear Models ◽

Hemodialysis Patients ◽

Weight Changes ◽

Mixed Linear Models ◽

Ultrafiltration Rate ◽

Chi Square ◽

Median Percentage ◽

Chi Square Analysis

Background Intradialytic hypertension, a phenomenon where blood pressure increases during hemodialysis, is associated with increased mortality in hemodialysis patients. The proportion of patients in which intradialytic hypertension persists over time is unknown. Methods In a retrospective cohort study, we studied all patients from our outpatient hemodialysis units that received ≥1 month of treatments during the period from January to August 2010. We reviewed all pre- and post-hemodialysis blood pressure and weight measurements from 22,955 treatments during this study period. We defined intradialytic hypertension as an increase in systolic blood pressure ≥10 mmHg from pre- to post-hemodialysis. Individual patients were defined as having persistent intradialytic hypertension if the change in blood pressure from pre- to post-hemodialysis, when averaged throughout the study period, was ≥+10 mmHg. We calculated weight changes between and during hemodialysis and defined ultrafiltration rate per treatment as ultrafiltration volume divided by minutes on hemodialysis. We compared patients with and without persistent intradialytic hypertension using chi-square analysis and mixed linear models. Results The prevalence of intradialytic hypertension was 21.3 per 100 treatments. The median percentage of intradialytic hypertension treatments per patient was 17.8% (9–31.3%, interquartile range). The prevalence of persistent intradialytic hypertension was 8 per 100 patients. Patients with persistent intradialytic hypertension had lower ultrafiltration rate compared to other patients (10.4 vs. 12.2 ml/min, p = 0.02). Conclusions Intradialytic hypertension is a persistent phenomenon in a subset of hemodialysis patients. Ultrafiltration rate was the only volume-related variable that differed between patients with and without persistent intradialytic hypertension.

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Providers’ Perceptions of Barriers to Optimal Communication With Patients During the Postcolonoscopy Experience

Journal of Patient Experience ◽

10.1177/2374373518759548 ◽

2018 ◽

Vol 5 (4) ◽

pp. 272-278

Author(s):

Travis Hyams ◽

Barbara Curbow ◽

Juliette Christie ◽

Nora Mueller ◽

Evelyn King-Marshall ◽

...

Keyword(s):

Standard Procedure ◽

Patient Characteristics ◽

Time Frame ◽

Perceived Barriers ◽

Short Term ◽

Communication Difficulties ◽

Nurses Perceptions ◽

Patient Barriers ◽

System Characteristics

Introduction: Colonoscopy screening is an effective method of detecting and preventing colorectal cancer. Standard procedure for most colonoscopies (98%) is to use conscious sedation, which can cause short-term cognitive impairment postprocedure, including communication difficulties. In this study, we explored providers’ (gastroenterology doctors and nurses) perceptions of the barriers to optimal communication with patients immediately following colonoscopy. Methods: We conducted interviews with 61 providers across 5 clinical configurations. Interviews were transcribed and coded with NVivo version 11 software. Results: Themes emerged regarding barriers to optimal provider–patient communication postcolonoscopy: patient barriers (sedation and patient characteristics), caregiver barriers, and system characteristics. Conclusions: Providers’ perceived barriers to communication are an important topic to study. They endorsed, in particular, interventions that target the postcolonoscopy time frame when patients may still be sedated, but providers must convey important discharge and follow-up instructions.

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Do Depressive Symptoms Shape Blacks’ Perceptions of Stress Over Time?

Innovation in Aging ◽

10.1093/geroni/igaa022 ◽

2020 ◽

Vol 4 (5) ◽

Author(s):

DeAnnah R Byrd ◽

Roland J Thorpe ◽

Keith E Whitfield

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Perceived Stress ◽

Ordinary Least Squares ◽

Community Dwelling ◽

Stressful Events ◽

Age Group ◽

The Impact ◽

Over Time

Abstract Background and Objectives Previous studies have linked stress to multiple negative mental health outcomes, including depression. This established stress–depression association is typically examined in one direction and cross-sectionally. This study examined the bidirectional relationships between depressive symptoms and changes in perceived stress over time in Blacks. Research Design and Methods The present study uses a community-dwelling sample of 450 Black adults, aged 51–96 years old, who participated in the Baltimore Study of Black Aging—Patterns of Cognitive Aging. Perceived stress—measured by the Perceived Stress Scale—and depressive symptoms—measured using the Center for Epidemiologic Studies Depression scale—were both assessed at baseline and follow-up 33 months later. Ordinary least squares regression was used to examine 2 bidirectional longitudinal relationships between (1) stress–depression and (2) depression–stress, and whether these associations are modified by age. Results Initial analyses testing the typical stress–depression relationship showed an effect in the expected direction, that is stress leading to more depressive symptoms over time, adjusting for model covariates, but the effect was not statistically significant (b = 0.014, p = .642). After accounting for baseline perceived stress level, age, sex, education, and chronic health conditions, depressive symptoms were positively associated with follow-up stress (b = 0.210, p < .000). The depression–stress association further varied by age group such that the impact of baseline depression on changes in perceived stress was greatest in Blacks in their 60s versus those in their 50s (b = 0.267, p = .001), controlling for model covariates. Discussion and Implications Contrary to previous work, the results suggest that an individual’s mental health shapes his/her perception of stressful events and this relationship varies by age group. While the typical finding (stress impacting depression) was not significant, the findings reported here highlight the importance of considering the possible bidirectional nature of the relationships between psychosocial measures of stress and mental health in later life among Blacks.

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Characteristics of stage III and IV M0 prostate cancer (PCa) patients in SEER-Medicare who develop bone metastasis (BM) following diagnosis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15146 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15146-e15146

Author(s):

Arif Hussain ◽

Ebere Onukwugha ◽

Jinani Jayasekera ◽

Diane L. McNally ◽

Brian S. Seal ◽

...

Keyword(s):

Stage Iv ◽

Patient Characteristics ◽

Stage Iii ◽

Age Group ◽

Diagnosis Code ◽

Exclusion Criteria ◽

Chi Square ◽

Medicare Database ◽

Stage Stage

e15146 Background: BM is diagnosed in 70-80% of men with metastatic PCa. Less is known about the timing of BM diagnosis following incident non-metastatic PCa and associated patient characteristics. In this study, we determined the incidence and timing of post-diagnosis BM (BMpd) among PCa patients (pts) by incident stage, age, race and year of diagnosis using a large observational dataset. Methods: We analyzed pts aged 66 or older from the linked Surveillance, Epidemiology, and End Results and Medicare (SEER-Medicare) database. Pts with PCa were identified between 2000 and 2007 and were followed until death, Medicare disenrollment, HMO enrollment, or end of the study (December 31, 2009). The cohort included incident stage III and IV(M0) PCa in SEER, and identified BM occurring either within (i.e., +/-) 1 month of the SEER diagnosis month (BM90) or beyond the initial 90-day window (BMgt90) based on the presence of at least one inpatient or one outpatient claim with a diagnosis code of 198.5. We calculated summary and chi-square statistics to examine BMpd, BM90, and BMgt90 by incident stage, age, race and year of PCa diagnosis. Results: Among 9,188 Stage III (72%) and IV(M0) (28%) PCa pts who met inclusion/exclusion criteria, 14.6% (n=1,345) had BMpd: 2.3% (n= 217) had BM90 and 12.3% (n=1,128) had BMgt90. Average age was 72 years and 9% were African American (AA). Incidence of BMpd varied by stage (stage III: 11%; stage IV/M0: 25%; p<0.001) and by age group (66-74 years: 13%; 75-84 years: 19%; >85 years: 22%; p<0.001) but not by race (White: 15%; AA: 16%; Other: 13%; p=0.49). The diagnosis BM90 and BMgt90 varied with stage (stage III: 2% and 9%; stage IV(M0): 4% and 21%; p<0.0001) and age (66-74 years: 2% and 11%; 75-84 years: 3% and 16%; >85 years: 5% and 17%; p<0.001). The incidence of BM decreased over time whether considering BMpd (19% in 2000 to 9% in 2007; p<0.001), BM90 (4% in 2000 to 2% in 2007; p=0.03) or BMgt90 (16% in 2000 to 6% in 2007; p<0.001). Conclusions: BM occurred in only 2% of incident stage III/IV(M0) PCa pts within 1 month of diagnosis, but nearly 15% were diagnosed with BM during a median follow-up of 57 months. Prevalence of BM was highest in stage IV(M0) and older pts.

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Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis

Health Technology Assessment ◽

10.3310/hta23250 ◽

2019 ◽

Vol 23 (25) ◽

pp. 1-98 ◽

Cited By ~ 3

Author(s):

Rod S Taylor ◽

Sarah Walker ◽

Oriana Ciani ◽

Fiona Warren ◽

Neil A Smart ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Exercise Capacity ◽

Meta Analysis ◽

Patient Characteristics ◽

Individual Participant Data ◽

Significant Difference ◽

Individual Participant ◽

The Impact

Background Current national and international guidelines on the management of heart failure (HF) recommend exercise-based cardiac rehabilitation (ExCR), but do not differentiate this recommendation according to patient subgroups. Objectives (1) To obtain definitive estimates of the impact of ExCR interventions compared with no exercise intervention (control) on mortality, hospitalisation, exercise capacity and health-related quality of life (HRQoL) in HF patients; (2) to determine the differential (subgroup) effects of ExCR in HF patients according to their age, sex, left ventricular ejection fraction, HF aetiology, New York Heart Association class and baseline exercise capacity; and (3) to assess whether or not the change in exercise capacity mediates for the impact of the ExCR on final outcomes (mortality, hospitalisation and HRQoL), and determine if this is an acceptable surrogate end point. Design This was an individual participant data (IPD) meta-analysis. Setting An international literature review. Participants HF patients in randomised controlled trials (RCTs) of ExCR. Interventions ExCR for at least 3 weeks compared with a no-exercise control, with 6 months’ follow-up. Main outcome measures All-cause and HF-specific mortality, all-cause and HF-specific hospitalisation, exercise capacity and HRQoL. Data sources IPD from eligible RCTs. Review methods RCTs from the Exercise Training Meta-Analysis of Trials for Chronic Heart Failure (ExTraMATCH/ExTraMATCH II) IPD meta-analysis and a 2014 Cochrane systematic review of ExCR (Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2014;4:CD003331). Results Out of the 23 eligible RCTs (4398 patients), 19 RCTs (3990 patients) contributed data to this IPD meta-analysis. There was a wide variation in exercise programme prescriptions across included studies. Compared with control, there was no statistically significant difference in pooled time-to-event estimates in favour of ExCR, although confidence intervals (CIs) were wide: all-cause mortality had a hazard ratio (HR) of 0.83 (95% CI 0.67 to 1.04); HF-related mortality had a HR of 0.84 (95% CI 0.49 to 1.46); all-cause hospitalisation had a HR of 0.90 (95% CI 0.76 to 1.06); and HF-related hospitalisation had a HR of 0.98 (95% CI 0.72 to 1.35). There was a statistically significant difference in favour of ExCR for exercise capacity and HRQoL. Compared with the control, improvements were seen in the 6-minute walk test (6MWT) (mean 21.0 m, 95% CI 1.57 to 40.4 m) and Minnesota Living with Heart Failure Questionnaire score (mean –5.94, 95% CI –1.0 to –10.9; lower scores indicate improved HRQoL) at 12 months’ follow-up. No strong evidence for differential intervention effects across patient characteristics was found for any outcomes. Moderate to good levels of correlation (R 2 trial > 50% and p > 0.50) between peak oxygen uptake (VO2peak) or the 6MWT with mortality and HRQoL were seen. The estimated surrogate threshold effect was an increase of 1.6 to 4.6 ml/kg/minute for VO2peak. Limitations There was a lack of consistency in how included RCTs defined and collected the outcomes: it was not possible to obtain IPD from all includable trials for all outcomes and patient-level data on exercise adherence was not sought. Conclusions In comparison with the no-exercise control, participation in ExCR improved the exercise and HRQoL in HF patients, but appeared to have no effect on their mortality or hospitalisation. No strong evidence was found of differential intervention effects of ExCR across patient characteristics. VO2peak and 6MWT may be suitable surrogate end points for the treatment effect of ExCR on mortality and HRQoL in HF. Future studies should aim to achieve a consensus on the definition of outcomes and promote reporting of a core set of HF data. The research team also seeks to extend current policies to encourage study authors to allow access to RCT data for the purpose of meta-analysis. Study registration This study is registered as PROSPERO CRD42014007170. Funding The National Institute for Health Research Health Technology Assessment programme.

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Pre- and post-treatment levels of serum high-sensitivity C-reactive protein in patients with lesions of endodontic origin: A clinical pilot study

Asian Journal of Oral Health and Allied Sciences ◽

10.25259/ajohas_1_2020 ◽

2020 ◽

Vol 10 ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

Rhythm Bains ◽

Aseem P. Tikku ◽

Wahid Ali ◽

Promila Verma ◽

Pragya Pandey

Keyword(s):

High Sensitivity ◽

Time Frame ◽

Post Treatment ◽

C Reactive Protein ◽

Reactive Protein ◽

Effect Of Treatment ◽

The Mean ◽

Hs Crp ◽

The Impact

Objective: The objective of the study was to evaluate the impact of lesions of endodontic origin (LEO) and their treatment on the patients’ serum high-sensitivity C-reactive protein (hs-CRP) levels. Materials and Methods: A total of 20 healthy patients with radiographic evidence of LEO in at least one tooth were recruited for the study, of which 11 were finally evaluated. Before initiating the endodontic treatment, 10 ml of patient’s venous was taken from the antecubital vein to assess the pre-operative serum hs-CRP levels (T0). Canals were prepared with K-files till a suitable size and irrigated with 2.5% sodium hypochlorite. At the subsequent appointment after 1 week, teeth were obturated. The patients were then recalled 30 days after the completion of endodontic therapy. Again blood samples will be taken at time-frame T1 to assess the serum hs- CRP levels. The change in pre- and post-treatment values for T0 and T1 was statistically evaluated to assess the effect of treatment on serum hs-CRP levels. Results: The mean CRP (mg/L) at T0 ± SD (Range) at baseline was 6.18 ± 3.72 (0.96–11.02) and the mean CRP at T1 ± SD (Range) was 3.92 ± 3.59 (1.108–11.04) and mean change in CRP ± SD (Range) after 30 days follow-up was −2.26 ± 3.04 (−8.26–1.16). Significance of change in CRP levels (Paired t-test) was t = 2.458; P = 0.034. Conclusion: The results of the present study indicate that root canal treatment reduced the levels of hs-CRP in the serum of the patients having LEO. Timely diagnosis and treatment of these lesions may have some contribution in reducing systemic inflammatory burden.

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412. Estimating the Impact of School Classroom Sizes on the Probability of Severe Acute Respiratory Syndrome Coronavirus-2 Infectivity or Exposure

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.613 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S307-S307

Author(s):

Sanya J Thomas ◽

Rebecca R Young ◽

Ibukunoluwa Akinboyo ◽

Michael J Smith ◽

Tara Buckley ◽

...

Keyword(s):

North Carolina ◽

Severe Acute Respiratory Syndrome ◽

Reproduction Number ◽

The United States ◽

Mitigation Strategies ◽

Age Group ◽

Cohort Size ◽

Research Support ◽

The Impact

Abstract Background Despite schools reopening across the United States in communities with low and high Coronavirus disease 2019 (COVID-19) prevalence, data remain scarce about the effect of classroom size on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) within schools. This study estimates the effect of classroom size on the risk of COVID-19 infection in a closed classroom cohort for varying age groups locally in Durham, North Carolina. Total number of Coronavirus Disease 2019 (COVID-19) infections over a 28-day follow-up period for varying classroom reproduction number (R0) and varying classroom cohort sizes of 15 students, 30 students and 100 students in Durham County, North Carolina. Methods Using publicly available population and COVID-19 case count data from Durham County, we calculated a weekly average number of new confirmed COVID-19 cases per week between May 3, 2020 and August 22, 2020 according to age categories: < 5 years, 5-9 years, 10-14 years, and 15-19 years. We collated average classroom cohort sizes and enrollment data for each age group by grade level of education for the first month of the 2019-2020 academic school year. Then, using a SEIR compartmental model, we calculated the number of susceptible (S), exposed (E), infectious (I) and recovered (R) students in a cohort size of 15, 30 and 100 students, modelling for classroom reproduction number (R0) of 0.5, 1.5 and 2.5 within a closed classroom cohort over a 14-day and 28-day follow-up period using age group-specific COVID-19 prevalence rates. Results The SEIR model estimated that the increase in cohort size resulted in up to 5 new COVID-19 infections per 10,000 students whereas the classroom R0 had a stronger effect, with up to 88 new infections per 10,000 students in a closed classroom cohort over time. When comparing different follow-up periods in a closed cohort with R0 of 0.5, we estimated 12 more infected students per 10,000 students over 28 days as compared to 14 days irrespective of cohort size. With a R0 of 2.5, there were 49 more infected students per 10,000 students over 28 days as compared to 14 days. Conclusion Classroom R0 had a stronger impact in reducing school-based COVID-19 transmission events as compared to cohort size. Additionally, earlier isolation of newly infected students in a closed cohort resulted in fewer new COVID-19 infections within that group. Mitigation strategies should target promoting safe practices within the school setting including early quarantine of newly identified contacts and minimizing COVID-19 community prevalence. Disclosures Michael J. Smith, MD, M.S.C.E, Merck (Grant/Research Support)Pfizer (Grant/Research Support)

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Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy: descriptive study

BMJ ◽

10.1136/bmj.m1835 ◽

2020 ◽

pp. m1835 ◽

Cited By ~ 10

Author(s):

Marco Piccininni ◽

Jessica L Rohmann ◽

Luca Foresti ◽

Caterina Lurani ◽

Tobias Kurth

Keyword(s):

Descriptive Study ◽

Time Frame ◽

Absolute Number ◽

Northern Italy ◽

Age Group ◽

Small Community ◽

All Cause Mortality ◽

Considerable Impact ◽

Italian City ◽

The Impact

Abstract Objective To quantify the impact of coronavirus disease 2019 (covid-19) on all cause mortality in Nembro, an Italian city severely affected by the covid-19 pandemic. Design Descriptive study. Setting Nembro, in the Bergamo province of Lombardy, northern Italy. Population Residents of Nembro. Main outcome measures Monthly all cause mortality between January 2012 and April 2020 (data to 11 April), number of confirmed deaths from covid-19 to 11 April 2020, and weekly absolute number of deaths between 1 January and 4 April across recent years by age group and sex. Results Nembro had 11 505 residents as of 1 January 2020. Monthly all cause mortality between January 2012 and February 2020 fluctuated around 10 per 1000 person years, with a maximum of 21.5 per 1000 person years. In March 2020, monthly all cause mortality reached a peak of 154.4 per 1000 person years. For the first 11 days in April, this rate decreased to 23.0 per 1000 person years. The observed increase in mortality was driven by the number of deaths among older people (≥65 years), especially men. From the outbreak onset until 11 April 2020, only 85 confirmed deaths from covid-19 in Nembro were recorded, corresponding to about half of the 166 deaths from all causes observed in that period. Conclusions The study findings show how covid-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the covid-19 pandemic can only be completely understood if, in addition to confirmed deaths related to covid-19, consideration is also given to all cause mortality in a given region and time frame.

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Flu fighters: Flu vaccine administrations in pediatric hematology oncology patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.131 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 131-131

Author(s):

Mehgan Beverley ◽

Patricia Lorenz ◽

Joel Kaplan ◽

Nicole Turner

Keyword(s):

Influenza Infection ◽

Target Population ◽

Time Frame ◽

Control Limit ◽

Similar Time ◽

Pediatric Hematology ◽

Flow Maps ◽

Phone Calls ◽

Flu Vaccine ◽

The Impact

131 Background: Influenza is a serious virus that affects millions of people every year. The CDC and AAP recommend all people starting 6 months of age get a yearly flu vaccine, especially the immunocompromised. Children receiving chemotherapy for cancer treatment are at heightened risk of severe influenza infection and resulting complications. (Goossen et al., 2013). Methods: An interdisciplinary team used the Model for Improvement with an aim statement, current and ideal process flow maps, and annotated run charts to monitor the impact of changes. Change ideas were tested via small-cycle PDSAs. Successful strategies included development of a flu form, targeting patients with pre-visit planning and phone calls, and escalation to physician intervention. Results: A p shewhart chart analyzed the percentage of target population receiving vaccines weekly. The goal was to vaccinate 95% of patients with leukemia or neuro-oncology on active chemotherapy who were older than 6 months of age without medical contraindications. At baseline, upper control limit (UCL) was 6%, mean was 2% and lower control limit (LCL) was 0%. After testing changes, the percentage of flu vaccines improved (special cause variation) to UCL 100%, mean 95%, LCL 87%. The goal was met and sustained through the end of 2018 flu season. This QI project also improved flu vaccinations given to all our patients as compared to the 2016/2017 flu season. During the 2016/2017 flu season, 295 flu vaccines were given. During the 2017/2018 flu season, 457 flu vaccines were given in a similar time frame, i.e. an increase of 155%. In addition to improving care delivered to our target population, this work facilitated greater distribution of flu vaccine to all at-risk populations in our clinic. Conclusions: This project shows a comprehensive and effective approach to reducing the risk of a serious health threat for some of our most vulnerable patients. By developing a well-defined process, standardizing messaging, and using data to inform next steps, our team surpassed benchmarks established by some of the best cancer care specialists in the country. The processes established here can be applied widely, offering hope that future flu seasons could be less devastating to vulnerable populations.

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