Reducing Racial Disparities in Influenza Vaccination Among Children With Asthma

Abstract

Introduction A multi-faceted intervention to raise influenza vaccination rates was tested among children with asthma. Methods In a pre-post design, eighteen primary care practices implemented the 4 Pillars™ Immunization Toolkit along with other strategies. The primary outcome was the difference in influenza vaccination rates at each practice among children with asthma during the baseline year (pre-intervention) and at the end of year 2 (post intervention), both overall and by race (white vs. non-white). Results Influenza vaccination rates increased significantly in 13 of 18 practices. The percent of vaccinated non-white children increased from 46% to 61% (P<0.01) and the percent of vaccinated white children increased from 58% to 65% (P<0.001). Likelihood of vaccination was significantly lower for non-white children pre-intervention (OR=0.66, 95%CI=0.59–0.73; P<0.001), but this difference was eliminated post intervention (OR=0.95, 95%CI=0.85–1.05; P=.289). Discussion A multi-strategy, evidence-based intervention significantly increased influenza vaccination uptake and reduced racial disparities among children with asthma.

Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

“…Lack of time or staff resources as barriers to screening remained unchanged. Providers : Logistic regression analyses controlling for the demographic characteristics (physicians’ practice setting and gender) found significantly higher rates of physicians in 2014 compared with 2008 reporting annual substance use screening (96 vs 88%, AOR 2.8, p = 0.04) and any use of a validated tool (56 vs 43%, AOR 1.8, p = 0.006). Procedures : NR Patients : NRNace 2011 [20]USVaccinationLong-term care facility# hospitals: 6# providers: NR# patients: NRPre-postAmerican Medical Directors Association Immunization Toolkit Implementation : Booklet with educational material and resources for increasing the uptake of vaccinations and managing influenza outbreaks, 2 DVDs Provider : NR Patient : NR Other intervention : Email distribution list, half-day of collaborative training offered to 3/6 facilities Uptake : NR Utility : NR Providers : NR Procedures : Facilities that received the toolkit alone experienced decreases in worker influenza (29.3% to 25.8%), resident influenza (78.9% to 58.2%), and resident pneumococcal (20.2% to 6.3%) immunization rates. Facilities who received the tooklkit and collaborative training increased rates by 10.9, 4, and 29.9 percentage points. Patients : NRNowalk 2014 [51]; Nowalk 2013 [51]; Nowalk 2012 [96]USVaccinationPrimary care# hospitals: 4# providers: 24# patients: 5592Pre-post4 Pillars Toolkit Implementation : Educational materials, case studies, lists of barriers, supplementary ideas, bibliography, organized in 4 pillars (convenient access, notification, office system changes such as immunizations given as part of vital signs, motivation elements such as feedb Provider : Standing order program, prompts in electronic medical record Patient : Leaflet, posters Other intervention : Introduction to toolkit in lunch meeting, weekly progress reports to immunization champion, online refresher course ($20 incentive) Uptake : All sites reported using at least 5/14 strategies Utility : Most staff at 3/4 sites believed the toolkit improved efficiency for adult vaccinations Providers : NR Procedures : Pneumococcal vaccination rates increased for high-risk adults (25 vs 40%, p = .02) but not for older adults (44% vs 52%, p = .26) and in 2/4 practices among both high-risk and older adults (p<.05); influenza vaccination rates increased significantly in 3/4 sites and overall (22 vs 33%, p < .001) Patients : NRZimmerman 2014 [46]; Lin 2016 [111]; Nowalk 2014 [54]; Nowalk 2016 [53]USVaccinationPrimary care# hospitals: 20# providers: NR# patients: 536-8183 patients/facilityRCT4 Pillars Toolkit for Increasing Childhood Influenza Immunization Implementation : see Nowalk et al (2013) Provider : see Nowalk et al (2013) Patient : see Nowalk et al (2013) Other intervention : EMR programmed to include best practice alert, visited to introduce the toolkit at a meeting, provided feedback on immunization rates, created online videos and a PSA for local TV, community outreach efforts, early delivery of vaccine, donated vaccines Uptake : All intervention sites used 1 or more elements of the toolkit Utility : NR Providers : NR Procedures : Intervention practices increased vaccination rates more than controls ( p = 0.034) Patients : NRAbraham 2007 [39]USWeight managementPrimary care# hospitals: 5# providers: 183# patients: NRRCT…”

Vaccinating in the Emergency Department, a Novel Approach to Improve Influenza Vaccination Rates via a Quality Improvement Initiative

“…9 Disparities in vaccination rates also exist based on age, race, ethnicity, and insurance status. 10 – 13 Barriers to receiving vaccines include educational deficiencies, fear or mistrust, and poor healthcare access. 14 To overcome these barriers, the CDC sponsors the Vaccines For Children (VFC) program, a federally funded US program that provides vaccines free of charge to qualified children: Medicaid-eligible, uninsured, under-insured, or American Indian and Alaskan Native.…”

A Systematic Review on Health Interventions Used in Enhancing Vaccination Uptake

“…Earlier review [25] had highlighted the needs to have provider training, development of guidelines, and tools for immunization district managers or computerized provider reminders. Strengthening service delivery system intervention should practice as routine agenda for monitoring and it had shown an improvement in access to the services [26,27]. According to Lin et al [15], using the immunization toolkit strategies increased the vaccination uptake.…”