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Improving Influenza Vaccine Uptake


Patient getting a shot in the upper arm.

Can hospitals help close the flu vaccination gap?

Suchitra Rao, MBBS, MSCS, has been keeping an eye on the land down under, and not just because she’s an Aussie herself. As a pediatric infectious disease specialist with a research interest in influenza, she’s anticipating how this year’s flu season might interplay with COVID-19, and the best place to look has been the part of the world where winter just happened.

“After mitigation measures went into place, cases of influenza virtually disappeared,” she says. “But in the U.S. our lockdown is not as strict. So a lot is still unknown.”

One thing that is known: The best way to mitigate the spread of the flu is vaccination, the more the better. Dr. Rao has been studying that for a long time. The following four studies illustrate her novel approach to improving flu vaccine uptake at Children’s Hospital Colorado.

Identifying missed opportunities for flu vaccination

Kids get hospitalized with influenza every season. At Children’s Colorado between 2010 and 2014, about 61% of them weren’t vaccinated. Dr. Rao wanted to know how many of those had missed an opportunity to get vaccinated that season, whether through a clinic setting, an emergency department visit or a prior hospitalization. The answer: 42% of them, meaning more than 40% of those hospitalizations might have been prevented.

Study: “Missed Opportunities for Influenza Vaccination Among Hospitalized Children With Influenza at a Tertiary Care Facility”

Perceived barriers to offering flu vaccine while in the hospital

If hospitals could kill two proverbial birds with one stone and vaccinate a child while they were there anyway, then why wasn’t it happening? Dr. Rao and team surveyed both parents and providers. It turned out most parents would agree to a flu vaccination during a hospitalization if it were offered. Many providers, however, perceived that parents would refuse a vaccination due to their child’s illness and misconceptions of the vaccine, although many also reported that they just didn’t think to offer it.

Study: “Exploring Provider and Parental Perceptions to Influenza Vaccination in the Inpatient Setting”

Exploring options for inpatient intervention

Armed with that insight, Dr. Rao and her team set out to explore how to increase the rate at which providers offered vaccinations to eligible hospitalized kids older than 6 months. They compared three groups: one group receiving provider reminders including prompts in the electronic health record and weekly emails indicating inpatient immunization status; another group receiving vaccine education for families; and a control group. The provider-targeted intervention was most effective, increasing vaccination orders for eligible patients to 52%. The family education group saw orders at 30% and the control group at 25%.

Study: “Evaluating Interventions to Increase Influenza Vaccination Rates Among Pediatric Inpatients”

InFLUencing inpatient vaccination rates

Dr. Rao’s team continues to refine those efforts through Children’s Colorado’s Be InFLUential campaign, which wraps providers, nurses, families, staff champions and robust data analytics into the effort. “We’ve automated a lot of it to make it easy to order the vaccine,” says Dr. Rao. “We review the data and work on ways to improve month to month. We’ve been thrilled to see how our efforts have blossomed.”

Last season, Children’s Colorado saw eligible medical inpatients receiving vaccines at a rate of 83%.

Study: “Be InFLUential: Evaluation of a Multifaceted Intervention to Increase Influenza Vaccination Rates Among Pediatric Inpatients”