Presumptively Initiating Vaccines and Optimizing Talk for Inpatients (PIVOT-IN): A Vaccine Communication Training Intervention for Pediatric Inpatient Clinicians - PROJECT SUMMARY/ABSTRACT Hospitals are a promising setting for reaching a large population of under-vaccinated children, many of whom lack a usual source of primary care or have underlying conditions that place them at increased risk for vaccine preventable diseases. Vaccination during hospitalization is especially critical for the NICHD priority populations of children who are underserved or experiencing health disparities. Up to 84% of hospitalized children are eligible for routine vaccines, yet most do not receive them during hospitalization. Reasons for this are multifactorial, including lack of awareness that a child is due or overdue for vaccines, parental concerns about vaccination during hospitalization, and limited clinician knowledge, skills, and comfort with discussing vaccines in the hospital setting. Data suggest that multimodal approaches that identify vaccine-eligible patients and promote evidence-based communication may increase equitable vaccine access, delivery, and acceptance. This project aims to develop and test a novel stakeholder-informed intervention to improve routine vaccination of hospitalized children. In Aim 1 of this proposal, the study team will engage hospital stakeholders, including parents, trainees, nurses, advanced practice providers, and attending physicians at Seattle Children’s Hospital in five design workshops to develop the ‘Presumptively Initiating Vaccines and Optimizing Talk for Inpatients (PIVOT-IN)’ intervention. PIVOT-IN will include two components: 1) a standardized screening approach to identify children eligible for routine vaccines during their hospitalization, and 2) a vaccine communication curriculum for inpatient clinicians to learn, practice, and use evidence-based communication techniques in their vaccine conversations with hospitalized patients and families. We envision the curriculum, adapted from the outpatient primary care setting, will include an introductory video, vaccine communication training sessions, and vaccine communication resources (i.e., scripted responses to common concerns), all tailored to the inpatient setting. The study team will engage an External Advisory Board of national experts and a health equity consultant as they draft and refine the intervention components. In Aim 2, the study team will use a prospective, season-matched, pre-post study design to test the intervention’s effectiveness in improving routine vaccination of vaccine-eligible hospitalized children. The study team will compare the proportion of vaccine-eligible children who receive ≥1 routine vaccine during their hospitalization between the baseline vs. intervention periods. In Aim 3, the study team will use mixed methods and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the intervention and identify key barriers, facilitators, and considerations for future dissemination. The findings will inform an R01 proposal to examine PIVOT-IN’s effectiveness in diverse hospital settings using a multi-center pragmatic clinical trial design. This novel intervention has the potential to markedly increase vaccination of high-risk children and could be readily adapted and expanded to other populations and settings with broad public health implications.
