Young Daniel G, Rogers Cortney S, Mayefsky Isaac, Neufeld Thomas, Niesen Angela, Reich Patrick J, Kao Carol M, Srinivasan Mythili
From the Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Mo.
Pediatr Qual Saf. 2025 Jan 7;10(1):e782. doi: 10.1097/pq9.0000000000000782. eCollection 2025 Jan-Feb.
Pediatric coronavirus disease 2019 (COVID-19) vaccination rates in the United States remain lower compared with adults. We aimed to (1) implement a quality improvement initiative to increase COVID-19 vaccination 2-fold in hospitalized patients 12-21 years of age from 4.7% during the baseline period (August 10, 2021-November 1, 2021) to 9.4% during the intervention phase (November 2, 2021-March 31, 2023) and (2) assess the importance of existing interventions and obtain feedback for future interventions to increase COVID-19 vaccination via a provider survey.
We conducted the quality improvement initiative in the inpatient units of a freestanding children's hospital. Interventions included provider education, electronic medical record best practice alerts, monthly competition, parental counseling to increase vaccine acceptance, and ensuring vaccine availability. The primary outcome measure was the percentage of hospitalized patients 12-21 years of age who received COVID-19 vaccine. Providers addressing COVID-19 vaccination with patients, as documented by COVID-19-specific problem lists, were a process measure. Length of stay was a balancing measure.
Although COVID-19 vaccination increased 1.6-fold during the initial 5 months of interventions, the interrupted time series analysis did not show a significant impact of our interventions on vaccination. Documentation of COVID-19 vaccine-specific problem lists increased 1.9-fold during most of the intervention period. There was no significant ( = 0.61) difference in length of stay between children in the baseline and intervention groups.
Despite our best efforts, we could not increase the number of COVID-19 vaccinations in our patients. Lessons learned suggest that creating a nurse-driven COVID-19 vaccine screening/ordering protocol and integrating COVID-19/influenza vaccination annually during influenza season can potentially increase vaccination rates, but further research is required.
美国2019冠状病毒病（COVID-19）儿科疫苗接种率仍低于成人。我们旨在：（1）实施一项质量改进计划，将12至21岁住院患者的COVID-19疫苗接种率提高两倍，从基线期（2021年8月10日至2021年11月1日）的4.7%提高到干预阶段（2021年11月2日至2023年3月31日）的9.4%；（2）通过提供者调查评估现有干预措施的重要性，并获取关于未来增加COVID-19疫苗接种干预措施的反馈。
我们在一家独立儿童医院的住院病房开展了质量改进计划。干预措施包括提供者教育、电子病历最佳实践警报、月度竞赛、家长咨询以提高疫苗接受度以及确保疫苗供应。主要结局指标是12至21岁住院患者中接种COVID-19疫苗的百分比。如COVID-19特定问题清单所记录，为患者提供COVID-19疫苗接种服务的提供者是一个过程指标。住院时间是一个平衡指标。
尽管在干预的最初5个月中COVID-19疫苗接种率提高了1.6倍，但中断时间序列分析未显示我们的干预措施对疫苗接种有显著影响。在大多数干预期间，COVID-19疫苗特定问题清单的记录增加了1.9倍。基线组和干预组儿童的住院时间无显著差异（P = 0.61）。
尽管我们尽了最大努力，但仍未能增加患者的COVID-19疫苗接种数量。经验教训表明，制定由护士主导的COVID-19疫苗筛查/订购方案，并在流感季节每年将COVID-19/流感疫苗接种整合在一起，可能会提高疫苗接种率，但还需要进一步研究。
