Influenza vaccine prevents influenza illness, hospitalization, and death. Hospitalized children are at
increased risk of influenza-related complications due to medical comorbidities. However, hospitalized children
have lower influenza vaccine coverage than the general population. Many hospitalized children do not have
good access to outpatient medical care where they could receive vaccine. Therefore, hospital visits are a
critically important encounter to provide influenza vaccine to eligible patients.
Clinical decision support (CDS) interventions have the potential to improve influenza vaccine uptake
and other health maintenance interventions in hospitalized children. Our long-term objective is to identify CDS
strategies that improve uptake of recommended health maintenance interventions in acute care settings. In this
proposal, we aim to develop and evaluate CDS to promote influenza vaccine in hospitalized children that can
be shared via CDS Connect for use across institutions. We will also identify insights that apply to CDS for
health maintenance interventions in acute care settings more generally.
In Aim 1 of this proposal, we will use user-centered design best practices to develop CDS to promote
influenza vaccine uptake for inpatients at three children’s hospitals within a single health system. We will first
perform a user and task analysis with relevant stakeholders to understand goals and barriers related to the
influenza vaccine administration process as well as provision of health maintenance interventions more
generally. We will then design candidate CDS strategies based on these insights and iteratively improve upon
them with stakeholders through scenario-based formative usability testing. Finally, we will evaluate CDS
effectiveness in simulations through summative usability testing. We will publish the final CDS strategy on
CDS Connect.
In Aim 2, we will implement the CDS sequentially across care settings within the three hospitals and
evaluate implementation effectiveness using the RE-AIM framework. We will use electronic health record
queries, surveys of operational leaders and CDS developers, and observations of admitting clinicians to
determine the reach of the intervention, its efficacy to improve influenza vaccine administration, adoption by
individual clinicians and organizational leaders, implementation fidelity, and costs of maintenance.
At the end of this project, we will have developed and evaluated a CDS process to promote influenza
vaccine in pediatric acute care settings at a single center. We will also have published the CDS strategy on
CDS Connect and associated it with key quantitative and qualitative data required by health systems to
facilitate implementation such as the expected impact, expected costs of implementation, and local
customization points for adaptation. These results will lay the groundwork for multicenter studies of CDS to
improve influenza vaccine uptake and related health maintenance interventions for hospitalized children.