Missed opportunities for influenza vaccination among inpatients with influenza
Methods: We conducted a retrospective chart review of inpatients with PCR-confirmed influenza admitted to Children’s Hospital Colorado from 2010-2014. Medical records were reviewed for patient demographics, prior visit type and characteristics. Missed opportunities for influenza vaccination were defined as prior visits for which the influenza vaccine was available in an underimmunized patient. Bivariable relationships were examined using chi-square tests.
We identified 352 inpatients with influenza. Of these, 309 (88%) were >6 months of age at diagnosis. 6 encounters were excluded due to repeat hospitalizations. 92/303 patients (30.4%) were completely vaccinated. 40 patients with unknown vaccination status were excluded from subsequent analyses. 30% (79/263) of patients had ≥1 missed opportunity for influenza vaccination. Of those with a missed opportunity, 33% (26/79) had one visit, 67% (53/79) had ≥2 visits. The median number of missed opportunity visits was 3 (range: 1-11). There were 246 missed opportunity visits; most were to specialty clinics (54%), followed by ED/Urgent Care (20%). 76% experienced their initial missed opportunity prior to the influenza season. 65% (51/79) had missed opportunities at “sick visits”.
170/263 (64 %) of patients were considered high risk. 76% of high risk patients vs 24% not at high risk had a missed opportunity visit (p=0.01). Patients with a metabolic syndrome or seizure disorder were more likely to have a missed opportunity visit (p<0.02 for both).
Conclusion: Nearly one third of inpatients with influenza had a missed opportunity for vaccination, the majority of whom were considered high risk for severe complications. Most visits occurred prior to the onset of the influenza season, but when vaccine was available. Subspecialty outpatient visits provide an excellent opportunity for influenza vaccination, as a means to target high risk patients, and because they represent the highest proportion of missed opportunities for vaccination.
J. Williams, None
M. Cunningham, None
M. Glode, None
K. Wilson, None