Quality improvement initiative improves lead screening and vaccinations in pediatric hospital setting

1. In this single center quality improvement study, 34.7% of previously missed vaccinations and lead exposure screenings were provided in a pediatric hospital setting.

2. An additional 30% of missed vaccination and lead exposure testing during hospitalization were addressed at follow up primary care visits.

Study Rundown: Population health and promotion in childhood are important goals, with most outreach strategies targeting primary care settings. There are serious gaps in vaccination rates to decrease vaccine-preventable diseases and lead exposure screening in high risk areas. This study aimed to identify care gaps (i.e., previously missed vaccinations and/or lead exposure testing) during pediatric hospitalization, using quality improvement (QI) initiatives within a multidisciplinary team. The goal was to increase closure of the two care gaps from 12% to 50% by administering missed vaccinations and/or testing for lead. During the study, inadequate staff assigned to review patient reports, brief length of hospital stay, and missing information on patient report limited the success in addressing care gaps. Overall, 34.7% of preventive care gaps in 1061 children were closed, with an overall improvement from 12% to 41%. Although the majority of care gaps were not closed at the end of the study period, with almost a third nonetheless addressed at follow up primary health visits, this study provides a feasible framework for improving pediatric health promotion in a hospital setting.

Click to read the study in PEDIATRICS

Relevant Reading: A primer on understanding pediatric health care quality measurement

In-Depth [Quality Improvement Study]: This quality improvement study included 1061 children aged 2 to 66 months within a primary care registry who were admitted to the hospital medicine service at a children’s hospital in Cincinnati, Ohio between July 2017 to April 2019. A multidisciplinary team of primary care physicians, hospital medicine physicians, nurses, and QI experts were involved in the study. The model involved Registered Nurses who initially identified care gaps on patient reports, who then communicated with the inpatient medicine team to administer vaccines and/or lead testing. A series of plan-do-study-act (PDSA) cycles were conducted to identify feasibility and failures of the model. In total, 648 of 1867 (34.7%) of care gaps were closed. Overall, care gaps were increased from 12% to 41%. Identification of care gaps increased from 62% to 88%. Furthermore, during a retrospective analysis, an additional 30% of care gaps not closed during hospitalization were addressed at primary care follow-up visits 1 month after discharge.

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