ESPE Abstracts

Introduction: The annual incidence of severe influenza infections reaches 5 million cases globally. Patients with diabetes mellitus (DM) are known to suffer more severe influenza infections, with increased mortality. Despite vaccination being recommended as standard of care, vaccination uptake rates have remained low for our DM patients. We undertook a quality improvement (QI) initiative to improve influenza vaccination uptake rates in our paediatric DM clinic.

Methods: Standard QI tools were employed for this initiative, beginning with understanding the expectations of the different stakeholders, process mapping, and constructing the affinity diagram. With the patient, staff, system and process factors identified through team brainstorming, a “cause-and-effect” fishbone diagram was constructed. A pareto chart was developed based on the factors that received the highest priorities by team members through independent voting. We proposed 4 interventions to target the root causes, which were executed through 3 Plan-Do-Study-Act cycles: (1) Inclusion of influenza vaccination in the DM Patient Management Template used in DM clinics, (2) Education Campaigns for the DM team to create awareness of the initiatives, (3) Patient Education Campaign through poster and patient-information leaflets, and (4) Inclusion of influenza vaccination in the electronic DM clinic documentation template. Data on vaccination offer and uptake rates were collected over a 10-month period.

Results: Our DM clinic had a mean of 84 patients per month. The median pre-intervention vaccination rate was 7.7%. At the first month of intervention, vaccination offer rate (surrogate for non-patient factors) was 40.9%, while vaccination uptake rate was 23.9%. After interventions (1) and (2), the median vaccination offer and uptake rates increased to 88.6% and 54.4% respectively. Post-interventions, the median vaccination uptake rate was 59.3% (maximum at 66.1%), while the median offer rate was 90.1% (maximum at 94.2%). Vaccination uptake rates reached a plateau around 60-65% towards the end of the initiative, which has been sustained to date. There were no serious adverse effects from influenza vaccination and no hospitalizations from influenza infections among DM patients during the study period. Using existing data and predictive models, the savings from the increase in influenza vaccination rates among DM patients is around SGD 250,000 (Euros 170,000) per year.

Conclusion: This QI initiative has established sustainable methods to improve vaccination uptake rates among paediatric DM patients, which translates into decreased morbidity and significant cost savings. These may benefit other high-risk groups with chronic disease who are at risk of severe influenza infection.