Vaccine Eligibility in Hospitalized Children
Vaccine Eligibility in Hospitalized Children
This study was a descriptive study of inpatient vaccination documentation and parental satisfaction with the vaccinations services. Institutional Review Board approval was obtained.
A convenience sample was obtained from hospitalized pediatric patients and their parents who received an infectious disease consultation from July 2011 to November 2011. All children between 2 months to 17 years of age were included. A convenience sample was used because immunization records are routinely obtained for patients as a part of the infectious disease consult. Immunization records for all other admissions are not routinely obtained. Exclusion criteria included any patient with an underlying contraindication to the universal vaccine schedule, including immunodeficiency or receiving chemotherapy. Neonates also were excluded because they had not yet been vaccinated in an outpatient setting; therefore the parents could not complete the satisfaction survey.
The study was conducted at a Midwest regional children's hospital with a total of 317 inpatient beds and an average of 15,000 yearly inpatient admissions. The institution has 40 subspecialty areas, including infectious disease. The infectious disease service averages 1,100 yearly inpatient consultations consisting of all ages of pediatric patients with a variety of diagnoses, including healthy children with intercurrent infection.
Inpatient Vaccination Documentation. A demographic sheet was completed, and information including age, sex, race, insurance status, and locations where the patient received all of his or her vaccines was obtained. A copy of the patient's vaccine record was reviewed if parents could provide it, and if it was not available, an interview of the patient's parent was undertaken to identify all vaccine providers. In all cases, the vaccine records from the medical home and any other vaccine providers were reviewed. Vaccine records were compared with the inpatient vaccine documentation reported in the initial history and physical. Inpatient documentation of vaccines and vaccine records were then compared with current ACIP guidelines. Vaccine status was evaluated based on age eligibility for individual vaccines. On-schedule receipt of the influenza vaccine was considered if the child had received the vaccine in the previous year if the admission occurred before the availability of the influenza vaccine for the current season. For any child who was behind on vaccines, caught-up vaccines were reported to their general inpatient team.
Parental satisfaction was evaluated with the Satisfaction with Immunization Service Questionnaire (SWISQ) (Box). The SWISQ is a 19-item questionnaire developed by Tickner, Leman, and Woodcock in 2010; it uses a 5-point Likert scale to evaluate parental satisfaction with vaccination services. Content and face validity were ensured both from past literature and interviews with parents (Tickner, Leman, & Woodcock, 2010). Reliability was established with internal consistency of the three subscales (organization, consultation, and listening/respecting) plus overall satisfaction using an α coefficient ranging from 0.74 to 0.94 (Tickner, Leman, & Woodcock, 2010). Only one subscale, organization, was below 0.8, with an α coefficient of 0.74 (Tickner, Leman, & Woodcock, 2010). The remainder of the subscales and overall satisfaction had high α coefficient levels from 0.87 to 0.94 (Tickner, Leman, & Woodcock, 2010).
Parents were given the SWISQ to complete at their convenience and were asked to rate their previous experience with immunization services. The survey was returned before their child was discharged from the hospital and before any immunizations, if needed, were given. An addressed interoffice envelope was provided to the parents, who placed the completed questionnaire into the interoffice envelope. The questionnaire was anonymous.
Statistical Program for Social Sciences (SPSS) version 18 was used to complete the data analysis. A power analysis was conducted a priori, and it estimated an appropriate sample size of 160 subjects to provide 80% power with an α set at 0.05. Power analysis was based on previous literature estimations of vaccination rates adhering to the ACIP guidelines at 70% to 80%. Descriptive statistics were conducted to summarize the data and explore the variability within the data. Pearson correlation was performed to measure the strength and association of the relationship between the variables of age, individual vaccines received, and overall vaccine status. Chi-square was used to analyze the categorical data.
Methods
Study Design
This study was a descriptive study of inpatient vaccination documentation and parental satisfaction with the vaccinations services. Institutional Review Board approval was obtained.
Participants
A convenience sample was obtained from hospitalized pediatric patients and their parents who received an infectious disease consultation from July 2011 to November 2011. All children between 2 months to 17 years of age were included. A convenience sample was used because immunization records are routinely obtained for patients as a part of the infectious disease consult. Immunization records for all other admissions are not routinely obtained. Exclusion criteria included any patient with an underlying contraindication to the universal vaccine schedule, including immunodeficiency or receiving chemotherapy. Neonates also were excluded because they had not yet been vaccinated in an outpatient setting; therefore the parents could not complete the satisfaction survey.
Setting
The study was conducted at a Midwest regional children's hospital with a total of 317 inpatient beds and an average of 15,000 yearly inpatient admissions. The institution has 40 subspecialty areas, including infectious disease. The infectious disease service averages 1,100 yearly inpatient consultations consisting of all ages of pediatric patients with a variety of diagnoses, including healthy children with intercurrent infection.
Measures and Data Collection
Inpatient Vaccination Documentation. A demographic sheet was completed, and information including age, sex, race, insurance status, and locations where the patient received all of his or her vaccines was obtained. A copy of the patient's vaccine record was reviewed if parents could provide it, and if it was not available, an interview of the patient's parent was undertaken to identify all vaccine providers. In all cases, the vaccine records from the medical home and any other vaccine providers were reviewed. Vaccine records were compared with the inpatient vaccine documentation reported in the initial history and physical. Inpatient documentation of vaccines and vaccine records were then compared with current ACIP guidelines. Vaccine status was evaluated based on age eligibility for individual vaccines. On-schedule receipt of the influenza vaccine was considered if the child had received the vaccine in the previous year if the admission occurred before the availability of the influenza vaccine for the current season. For any child who was behind on vaccines, caught-up vaccines were reported to their general inpatient team.
Parental Satisfaction
Parental satisfaction was evaluated with the Satisfaction with Immunization Service Questionnaire (SWISQ) (Box). The SWISQ is a 19-item questionnaire developed by Tickner, Leman, and Woodcock in 2010; it uses a 5-point Likert scale to evaluate parental satisfaction with vaccination services. Content and face validity were ensured both from past literature and interviews with parents (Tickner, Leman, & Woodcock, 2010). Reliability was established with internal consistency of the three subscales (organization, consultation, and listening/respecting) plus overall satisfaction using an α coefficient ranging from 0.74 to 0.94 (Tickner, Leman, & Woodcock, 2010). Only one subscale, organization, was below 0.8, with an α coefficient of 0.74 (Tickner, Leman, & Woodcock, 2010). The remainder of the subscales and overall satisfaction had high α coefficient levels from 0.87 to 0.94 (Tickner, Leman, & Woodcock, 2010).
Parents were given the SWISQ to complete at their convenience and were asked to rate their previous experience with immunization services. The survey was returned before their child was discharged from the hospital and before any immunizations, if needed, were given. An addressed interoffice envelope was provided to the parents, who placed the completed questionnaire into the interoffice envelope. The questionnaire was anonymous.
Statistical Analysis
Statistical Program for Social Sciences (SPSS) version 18 was used to complete the data analysis. A power analysis was conducted a priori, and it estimated an appropriate sample size of 160 subjects to provide 80% power with an α set at 0.05. Power analysis was based on previous literature estimations of vaccination rates adhering to the ACIP guidelines at 70% to 80%. Descriptive statistics were conducted to summarize the data and explore the variability within the data. Pearson correlation was performed to measure the strength and association of the relationship between the variables of age, individual vaccines received, and overall vaccine status. Chi-square was used to analyze the categorical data.
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