IMPORTANCE Hospitalized children are at increased risk of influenza-related complications, yet influenza vaccine coverage remains low among this group. Evidence-based strategies about vaccination of vulnerable children during all health care visits are especially important during the COVID-19 pandemic. OBJECTIVE To design and evaluate a clinical decision support (CDS) strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted among children eligible for the seasonal influenza vaccine who were hospitalized in a tertiary pediatric health system providing care to more than half a million patients annually in 3 hospitals. The study used a sequential crossover design from control to intervention and compared hospitalizations in the intervention group (2019-2020 season with the use of an intervention order set) with concurrent controls (2019-2020 season without use of an intervention order set) and historical controls (2018-2019 season with use of an order set that underwent intervention during the 2019-2020 season). INTERVENTIONS A CDS intervention was developed through a user-centered design process, including (1) placing a default influenza vaccine order into admission order sets for eligible patients, (2) a script to offer the vaccine using a presumptive strategy, and (3) just-in-time education for clinicians addressing vaccine eligibility in the influenza order group with links to further reference material. The intervention was rolled out in a stepwise fashion during the 2019-2020 influenza season. MAIN OUTCOMES AND MEASURES Proportion of eligible hospitalizations in which 1 or more influenza vaccines were administered prior to discharge. RESULTS Among 17 740 hospitalizations (9295 boys [52%]), the mean (SD) age was 8.0 (6.0) years, and the patients were predominantly Black (n = 8943 [50%]) or White (n = 7559 [43%]) and mostly had public insurance (n = 11 274 [64%]). There were 10 997 hospitalizations eligible for the influenza vaccine in the 2019-2020 season. Of these, 5449 (50%) were in the intervention group, and 5548 (50%) were concurrent controls. There were 6743 eligible hospitalizations in 2018-2019 that served as historical controls. Vaccine administration rates were 31% (n = 1676) in the intervention group, 19% (n = 1051) in concurrent controls, and 14% (n = 912) in historical controls (P < .001). In adjusted analyses, the odds of receiving the influenza vaccine were 3.25 (95% CI, 2.94-3.59) times higher in the intervention group and 1.28 (95% CI, 1.15-1.42) times higher in concurrent controls than in historical controls. (continued) Key Points Question Is a clinical decision support (CDS) strategy associated with improved influenza vaccination rates before discharge among eligible hospitalized children? Findings In this quality improvement study, the combinination of a defaultchecked influenza vaccine order in admission order sets for eligible p...
Objective Safe care of central venous access devices (CVAD) requires clinicians be able to identify key CVAD properties from insertion until safe removal. Our objective was to design and evaluate interfaces to improve CVAD documentation quality and information retrieval. Materials and Methods We applied user-centered design (UCD) to CVAD property documentation interfaces. We measured expert agreement and front-line clinician accuracy in retrieving key properties in CVADs documented pre- and postimplementation. Results The new approach (1) optimized searches for line types, (2) enabled discrete entry of key properties which propagated to the display name, and (3) facilitated error correction by experts. Expert agreement on key CVAD properties improved from 42% to 83% (P < 0.01). Frontline nurses’ perception of key CVAD properties improved from 31% to 86% (P < 0.01). Ease of use scores improved from 15/100 to 80/100 (P < 0.01). Conclusions UCD significantly improved data quality and nurse perception of CVAD properties to guide subsequent care.
BACKGROUND Predictive models may help providers tailor asthma therapies to an individual’s risk of exacerbation. The effectiveness of asthma risk scores on provider behavior and pediatric asthma outcomes remains unknown. OBJECTIVE Determine the impact of an electronic health record (EHR) vendor-released model on outcomes for children with asthma. METHODS We implemented a vendor Risk of Pediatric Asthma Exacerbation model as a non-interruptive risk score visible in the patient schedule view beginning 2/24/2021 in allergy and pulmonology clinics with 6 volunteer providers. We conducted a difference-in-differences analysis from 2/24/2019 – 2/23/2022 with a control group of other providers in the same departments. Primary outcomes included asthma hospitalization, ED visit, or oral steroid course within 90 days of an outpatient encounter. Volunteer providers were also interviewed to identify barriers and facilitators to model use. RESULTS The adjusted difference-in-differences estimators for the hospitalization, ED visit, oral steroid, and composite outcomes were -0.9% (95% CI: -1.6 to -0.3), –2.4% (-3.9 to -0.8), –1.9% (-4.3 to 0.5), and –2.3% (-4.7 to 0.2). In qualitative analysis, providers generally understood the purpose of the model and felt that it was useful to flag high exacerbation risk. Trust in the model was generally calibrated against providers’ own clinical judgement. CONCLUSIONS This EHR vendor model implementation was associated with a significant decrease in asthma hospitalization and ED visits within 90 days of pediatric allergy and pulmonology clinic visits, but not oral steroid courses.
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