753 - Use of Provider Education, Incentives, and Peer Competition to Increase COVID-19 Vaccination Rates Among Hospitalized Children

Vaccination against the novel coronavirus disease 2019 (COVID-19) is a key public health measure to reduce morbidity and mortality. COVID-19 vaccine uptake in pediatric patients has consistently lagged uptake in adults in the United States (US), with 83% of adults having completed the two-dose primary COVID-19 vaccine series compared to only 58% of 12- to 17-year-olds.

Objective:

The goal of this quality improvement (QI) initiative is to increase the percentage of unvaccinated hospitalized children 12 to 21 years old who receive COVID-19 vaccination in the hospital two-fold during the intervention phase (11/3/2021-3/31/2023) compared to the baseline period (08/10/2021-11/2/2021).

Design/Methods:

The QI initiative was conducted in the inpatient units of a free-standing children’s hospital in the midwestern US. Interventions included electronic medical records (EMR) reminders, provider education, provider incentives in the form of maintenance of certification (MOC) credits for participation, and monthly peer competition. The primary outcome measure was the percentage of unvaccinated, hospitalized children 12 to 21 years old who received the COVID-19 vaccine. Process measure was the percentage of patients queried about COVID-19 vaccination status by using the problem lists regarding COVID-19 vaccination status entered in the EMR. Length of stay was a balancing measure. The primary outcome and process measures were plotted in a statistical process control p chart.

Results:

There was no increase in the overall percentage of unvaccinated, hospitalized children receiving the COVID-19 vaccine during the intervention phase (5.6%) compared to baseline (5.2%) (Figure 1).  However, we did note a significant increase in vaccination (10.1%) during 9/6/22-12/26/22, a period during which an existing nurse-driven influenza vaccination protocol was initiated. There was an increase in the number of patients discharged with at least one dose of the COVID-19 vaccine (received prior to or during admission) during the intervention phase (48.2%) compared to baseline (40.8%) (Figure 2). COVID-19 vaccination queries as measured by COVID-19 vaccine-related problem in the EMR increased 2.3-fold from 9.9% at baseline to 22.6% during the intervention phase (Figure 3).

Conclusion(s):

Resident education, EMR triggers, and MOC credit to faculty for QI participation did not increase COVID-19 vaccine uptake in a midwestern US children’s hospital. The reasons for this are likely multifactorial and include provider factors and social factors unique to the COVID-19 vaccine.