LAS VEGAS — A simple two-step procedural change dramatically increased the percentage of pediatric patients with inflammatory bowel disease (IBD) who received the flu vaccine, researchers reported here.
Influenza vaccine administration increased from 10% in the 2015-2016 season to 58% in the 2016-2017 flu season (P<0.01), according to Claire Keith, MD, of Children's of Alabama in Birmingham, and colleagues.
Also, the rate of documentation that the clinician had recommended vaccination to IBD patients increased from about 46% to 82% in the 2016-2017 season (P<0.01), they said in a poster at the Crohn's and Colitis Congress.
“Patients with inflammatory bowel disease on immunosuppression are at increased risk for contracting influenza or developing severe complications,” the researchers noted. To increase the vaccination rate in these patients, the authors initiated a Plan-Do-Study-Act (PDSA) cycle in June 2016.
The PDSA had two steps: Offer flu vaccination in the IBD clinic and require that the IBD clinic physician record in the patient electronic health record (EHR) that the recommendation for vaccination was made.
“The PDSA cycle reviewed IBD clinic workflow and incorporated offering influenza vaccination in the clinic for the first time,” the authors explained. “A reminder for the provider to recommend influenza vaccination was also included in pre-visit planning meetings held prior to each clinic visit.”
After the PDSA changes were instituted, a second retrospective chart review was done in June 2017. Chi-square testing compared the percentage change in flu vaccine administration and EHR documentation of vaccine status from the 2015-2016 to 2016-2017 influenza season, they noted.
The study included 119 patients seen in the IBD clinic, and Keith reported that about 58% of those patients received their vaccine at the clinic, while about 38% were vaccinated at the primary care physician or pediatrician office, and about 5% were vaccinated at school.
“By offering the influenza vaccination in the inflammatory bowel disease clinic, the rate of influenza vaccination of clinic patients increased by 49%.” the researchers reported. “The rate of documentation of influenza vaccine status increased by 36%.”
“Given the high percentage of patients who received the vaccination at the inflammatory bowel disease clinic, we believe they would have not received the vaccination otherwise,” said co-author Traci Jester, MD, of the University of Alabama at Birmingham.
Athos Bousvaros, MD, of Boston Children’s Hospital told MedPage Today that “In this study, the gastrointestinal clinic became the medical home for getting the vaccinations done. The key thing here is they did two very simple things: ‘We are going to give it in the clinic and we are going to have the doctors talk about it in the clinic.’ Two simple interventions made a huge difference.”
Bousvaros, who was not involved in the study, explained that PDSA is a common technique used in quality improvement projects. “The idea is to identify a problem and do something about it. In this case, the problem is obvious: People weren’t getting their flu shots. Just 10% were getting their shots, and this is a big problem because the flu can be a serious issue in immune compromised patients.”
But Bousvaros pointed out that even with the documented recommendation, “it still is just 60% of the total, so there is still room for improvement.” He added that study demonstrated that “you just have to decide to give the vaccination in the clinic and not punt it to the primary care physician.”
Keith and Jester disclosed no relevant relationships with industry.
Bousvaros disclosed relevant relationships with Prometheus, Janssen, AbbVie, Takeda, and Shire.