1391 - Enhanced Education and Administration of Influenza Vaccine in a Pediatric Subspecialty Practice.

Background: Strategies to increase influenza (flu) immunization rates are desirable.  Some children who are at increased risk for severe disease may only be seen in a subspecialty office during the months when flu vaccine is offered.  Subspecialists may also provide education for families that are uncertain about benefits of vaccines.

Methods: During the 2019- 2020 season, our multispecialty pediatric practice, which includes divisions of Endocrinology, Gastroenterology, Infectious Disease, Nephrology, Pulmonary, and Surgery, initiated a quality project to increase delivery of flu vaccine during visits. Beginning 10/1/19, providers were encouraged to use tools in the electronic medical record (EMR) to ask about flu vaccine status and administer if indicated and accepted.  Flu immunizations given for all divisions, as well as individual divisions, were compared with the previous 2018–2019 season.

Results: From 9/1/19 -3/31/20, 615 doses of flu vaccine were administered for 5667 patients for a rate of 10.9 %. This was an increase from 9/1/18- 3/31/19 when 256 doses were given for 5760 patients (4.4%, p< .0001).  All divisions had a significant increase in flu vaccine rates except for infectious disease. Review of certain high risk disorders showed significant increased rates for diabetes and asthma but not for inflammatory bowel disease, HIV infection, chronic renal disease, or cystic fibrosis. During this project an EMR flu tool was not used for 1788 patients (32%). Of the remaining 3879 patients, 1982 (51%) reported prior receipt of flu vaccine and 579 (15%) were not eligible for state supplied vaccine. For 1318 eligible patients, flu vaccine was accepted by 631 (48%) and given to 615 patients. Flu vaccine was declined by 687 (52%) patients.

Conclusion: There is opportunity to provide education and flu vaccine during pediatric subspecialty visits.  All specialties increased the number of flu vaccine given except for infectious disease. This is likely because this division has routinely offered flu vaccine and visits for travel declined in 2020.  Although the practice overall gave more flu vaccine from the prior year, there appear to be missed opportunities.  Further quality improvement work will strengthen the EMR flu screening tools to increase participation and learn more about why flu vaccine is declined.