Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Participation in Hospital Influenza Collaborative Is inFLUential in Improving Vaccination Rates in Patients with Juvenile Idiopathic Arthritis and Systemic Lupus Erythematosus.

Taylor1,  Janalee, Haddix2,  Elaine F., Badinghaus3,  Kim, Burns1,  Mary Beth, Moore4,  Terry M., Ranz1,  Julie V., Anneken1,  Amy

Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Cincinnati Children's Hospital MC, Cincinnati, OH
Cincinnati Children's Hospital Center, Cincinnati, OH
Cincinnati Chiildren's Hospital Medical Center, Cincinnati, OH

Background/Purpose:

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can result in mild to severe illness, with noted reports of pediatric influenza related deaths. Influenza related morbidity and mortality can be decreased by improving flu vaccination rates. Children with rheumatic disease and those who are on immunosuppressive medications are at increased risk of complications related to influenza. The purpose of this study is to increase flu vaccination rates in patients with Juvenile Idiopathic Arthritis (JIA) and Systemic Lupus Erythematosus (SLE) through participation in hospital-wide influenza collaborative.

Methods:

2010–2011 CDC Influenza Vaccine Recommendations were reviewed. Target populations for pediatric rheumatology clinic were identified. Inclusion criteria for JIA consisted of: Rheumatology patients seen in the last year with a Primary DX code of 714.3, 714.32, 714.33 taking immunosuppressive medications of: methotrexate, sulfasalzine, leflunomide, cyclosporin, mycophenolate mofetil, azathioprine, etanercept, adalimumab, anakinra, infliximab, rituximab, abatacept, canakinumab, tocilizumab, rilonocept, or corticosteroids. SLE patients included rheumatology patients seen in the last year with a Primary DX code for Lupus is 710. Cohorts for JIA and SLE were pulled using Epic Clarity reports and lists were examined for appropriateness of eligibility criteria. Interventions included: reminder cards mailed to target patient population, Epic Influenza Best Practice Alert for target populations, standardized order sets, RN order placement for influenza, and process education for staff.

Results:

Two hospital-wide goals for 2010 season were set: 1) 87% of divisions would achieve an 80% immunization goal (vaccinated or actively declined) by January 15, 2011; 2) 75% of target populations would achieve at least 75% actual vaccination (through clinic or PMD). 18 divisions participated in the collaborative with identification of 35 high risk populations. Collaborative-wide results revealed 72% of divisions achieving immunization goal. 80% of identified target populations received actual vaccine. The pediatric rheumatology 2010 patient cohort consisted of 313 and 124 JIA and SLE patients respectively. 94% of JIA and 89% of SLE patients achieved immunization goal of vaccination or decline. Percent of JIA and SLE receiving actual vaccination was 94% and 80% respectively. Comparison of vaccination rates from 2009 to 2010 revealed implementation of Best Practice Alert resulted in 20–25% improvement. Insurance status had no effect on immunization rates in rheumatology patients.

Conclusion:

Participation in hospital-wide flu collaborative is valuable program to increase influenza vaccination rates for high risk pediatric rheumatology populations. Key interventions included involvement of front-line nurses with process and Epic implementation, development of Epic Best Practice Flu Alert system and standardized order sets. Consistent data feedback to teams/divisions and automated Best Practice Alerts are useful tools for driving performance.

To cite this abstract, please use the following information:
Taylor, Janalee, Haddix, Elaine F., Badinghaus, Kim, Burns, Mary Beth, Moore, Terry M., Ranz, Julie V., et al; Participation in Hospital Influenza Collaborative Is inFLUential in Improving Vaccination Rates in Patients with Juvenile Idiopathic Arthritis and Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1578
DOI:

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