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Abstract
Hospitalized children are at increased risk of influenza-related complications; however, influenza vaccine coverage remains low among this group. We aim to evaluate the effectiveness of a suite of clinical decision support (CDS) strategies to improve inpatient influenza vaccination in children. We conducted this retrospective cohort study among hospitalized children eligible for the seasonal influenza vaccine. We evaluated the influence of various CDS strategies on influenza vaccine administration rates from September 1, 2018, through May 1, 2022, using mixed-effects logistic regression adjusting for influenza season and demographic factors. In addition to our original CDS (prechecked influenza vaccine order in admission order sets), we designed and implemented 2 additional novel CDS tools, ie, vaccine status notifications and a conditional discharge alert on a patient who had an order without influenza vaccination administration, which were implemented using a sequential crossover design from control to intervention. There were 46 706 eligible hospitalizations across the 4 influenza seasons. In multivariable analysis, all 3 CDS interventions significantly improved influenza vaccine rates compared to those who did not receive any intervention (influenza vaccine order group: adjusted odds ratio [aOR] 2.28, 95% CI: 2.14-2.42; conditional discharge alert: aOR 1.82, 95% CI: 1.56-2.12; vaccine status notifications: aOR 1.19, 95% CI: 1.04-1.37). Vaccination was highest in the 2019 to 2020 influenza season, with falling rates in the subsequent years (2021-2022 season: aOR 0.34, 95% CI: 0.28-0.40). CDS improved influenza vaccination rates in hospitalized children. However, decreased rates over time may indicate waning CDS effectiveness or external factors such as COVID-19, as well as increased vaccine hesitancy.
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