The study, which is particularly timely given the busy and sometimes deadly 2003 influenza season, will be presented May 1 at the annual Pediatric Academic Societies meeting in San Francisco.
A team led by Maria Britto, MD, a physician in the division of Adolescent Medicine at Cincinnati Children's, examined whether proven, successful immunization strategies could be implemented in a specialty outpatient hospital setting and spread, using a business-world model, to other hospital outpatient settings. The result was a substantial increase in immunization rates in a clinic where immunization is essential to child health, and immunization rates in other clinics that are higher than the national average.
"Overall, 60 percent of the target population was immunized - twice that of most published pediatric influenza immunization rates," says Dr. Britto. "In the cystic fibrosis clinic, where immunizations are particularly important, rates were above 90 percent, which is the highest of any published report. By systematically planning for and addressing barriers in our systems, we were able to bridge the gap between what is known to be effective and what happens in the real world."
The project began in 2001 when, as part of a larger quality improvement initiative, the cystic fibrosis clinic implemented a series of immunization improvement strategies. These strategies included development of a paper-based tracking system, collaboration with the pharmacy to ensure vaccine was consistently available, mailed postcard reminders to all families, open access scheduling for shots, in-clinic reminders to patients and providers, prominently posted results, and phone calls to those not immunized by a certain date.
After seven weeks, the immunization rate was 77 percent, and by December 2002 it was 90.4 percent. Prior to the project, the immunization rate was 41 percent.
In 2003, the project was extended to other areas of the hospital. This required a plan to "engage and educate clinicians in other divisions, to minimize organizational barriers and to develop a 'tool kit' that would provide easy implementation of the strategies that had been effective in the cystic fibrosis clinic," says Dr. Britto.
In addition to some of the successful strategies used in the cystic fibrosis clinic, the team implemented strategies to foster innovation known in the business world as 'diffusion of innovation.' These strategies included:
- Demonstrating the clear advantage of the new way
- Compatibility with the current system and values
- Simplicity of the change and its innovation
- Ease of testing before making a full commitment
- The ability to observe the change and its impact
The project was funded by an initiative of the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement called Pursuing Perfection: Raising the Bar for Health Care Performance. Cincinnati Children's was one of seven health care organizations from across the nation chosen to receive a $1.9 million grant as part of the second stage of the groundbreaking, $20.9 million initiative. Cincinnati Children's is the only pediatric facility among the seven organizations chosen.
Cincinnati Children's Hospital Medical Center is a 423-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, patient-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health. Additional information can be found at www.cincinnatichildrens.org.