(Boston) – Jan. 5, 2015 – Boston Medical Center (BMC) has significantly improved influenza, or flu, vaccination rates among pediatric patients with sickle cell disease (SCD) during the last two flu seasons. Through quality improvement measures, such as using a patient navigator and enhanced electronic medical records, BMC increased vaccination rates in pediatric patients with SCD from 45 percent in 2011-12, to 80 percent and 90 percent in the 2012-13, and 2013-14 flu seasons, respectively. The findings were published online in advance of print in the journal Pediatric Blood & Cancer.
Children diagnosed with SCD, the most common inherited blood disorder in the U.S., often have a higher risk of complications from the flu when compared to the general public, and are hospitalized at a rate 56 times that of children without SCD, according to a previous study.
For this study, BMC tracked 180 pediatric hematology patients, aged 6 months to 21 years old, during the 2012-2013 and 2013-2014 flu seasons. The Center for Disease Control and Prevention (CDC) recommends receipt of the flu vaccine as early as possible, defining “early season” flu vaccination as given before mid-November. BMC researchers calculated the proportion of children with SCD who received the flu vaccine by Nov. 15 and found rates rose from 45 percent in 2012-2013 to 71 percent in 2013-2014, compared with only 34 percent in 2011-2012.
Overall, 45 percent of BMC’s pediatric SCD patients were vaccinated during the 2011-2012 season. BMC then implemented several quality improvement methods to achieve the substantial increase to a 90 percent vaccination rate.
“While national data is limited for vaccination rates among sickle cell disease patients, select studies have focused on the issue, and 90 percent is the highest vaccination rate we have ever seen reported,” said Amy Sobota, MD, MPH, of the division of pediatric hematology-oncology at BMC and the study’s lead author.
Since 1978, the CDC has recommended that patients of all ages with SCD get an annual flu vaccine, but a survey by the CDC revealed that only 50 percent of parents of a child with SCD said their child “had received or had an appointment scheduled to receive flu vaccine” during the 2011-2012 flu season.
In 2012, based on previous findings and experience treating SCD, BMC began supplying providers and parents with educational materials emphasizing the importance of flu vaccination for children with SCD. By enhancing patients’ electronic health records (EHRs) to integrate immunization dates directly into the clinic reminders, and creating an SCD-specific patient registry, BMC increased vaccination rates to 80 percent within the first year of implementation. A patient navigator was then brought in to review immunization reports from the registry, contact families directly to document flu vaccinations, or help the family identify the most convenient place to obtain the flu vaccine.
“This research demonstrates that close to universal vaccination is possible for children and adolescents with SCD, and it should serve as a benchmark for other practices,” Sobota said. “However, more work needs to be done to demonstrate the improvement in health status and cost savings of these flu vaccinations.”
With the increase in vaccination rates, BMC met, and then surpassed Healthy People’s 2020 goal of having 80 percent of children aged 6 months to 21 years old vaccinated against the flu. Managed by the U.S. Department of Health and Human Services, Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans.
BMC’s SCD team, part of the Pediatric Hematology and Oncology Program, offers state-of-the-art evaluation, diagnosis and treatment of blood disorders, and works closely with Boston University’s Center of Excellence in Sickle Cell Disease. Research included in this study was supported in part by the Health Resources and Services Administration as part of a grant to improve overall care for patients with SCD at BMC. For more information on BMC’s sickle cell disease program, visit their webpage.