BACKGROUND AND OBJECTIVES Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits, but few such programs have been described. METHODS We conducted a quality improvement initiative at an academically affiliated federally qualified health center that provides primary, specialty, and PUC services to children. Our PUC began offering routine immunizations in July 2020. The percentage of visits by eligible patients age ≤21 years during which immunization screening (process) and administration (outcome) occurred was measured from March 1, 2021, to February 19, 2023. Administration rates were measured across age, sex, race, language, and medical home groups. Data were analyzed with statistical process control methods. Grievance and adverse event data were monitored (balancing). RESULTS We completed 4 plan-do-study-act cycles. Provider-facing bundles that included training, decision support, electronic health record signaling, and financial incentives were not associated with meaningful changes in screening and administration (cycles 1-3). A dedicated nurse vaccinator (DNV) was added on October 31, 2022 (cycle 4). The mean screening rate increased from 44.7% to 67.4% during the DNV period, and the mean administration rate increased from 26.5% to 50.8%. Lower administration rates were observed during visits by Black and English-speaking patients, and by patients empaneled outside our site. CONCLUSIONS Provider-facing interventions alone were not effective at increasing vaccine screening and administration in our PUC, but marked improvement was observed with the addition of a DNV. Future interventions are needed to address disparities. Additional investigation is needed to determine whether our results are reproducible in other PUCs with access to vaccines.

中文翻译：

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通过儿科紧急护理诊所实施免疫接种服务。


背景和目标儿科紧急护理 （PUC） 中心可以通过在急性护理就诊期间提供疫苗接种来支持免疫接种活动，但很少有此类计划被描述。方法 我们在一家学术附属的联邦合格健康中心开展了一项质量改进计划，该中心为儿童提供初级、专业和 PUC 服务。我们的 PUC 于 2020 年 7 月开始提供常规免疫接种。从 2021 年 3 月 1 日至 2023 年 2 月 19 日，测量了年龄在 ≤21 岁之间的符合条件的患者进行免疫筛查（过程）和给药（结果）的就诊百分比。跨年龄、性别、种族、语言和医疗家庭组测量给药率。使用统计过程控制方法分析数据。监测不满和不良事件数据 （平衡）。结果 我们完成了 4 个计划-执行-研究-行动周期。包括培训、决策支持、电子健康记录信号和经济激励在内的面向提供者的捆绑服务与筛查和管理的有意义变化无关（第 1-3 周期）。2022 年 10 月 31 日（第 4 周期）增加了一名专门的护士疫苗接种员 （DNV）。DNV 期间平均筛查率从 44.7% 提高到 67.4%，平均给药率从 26.5% 提高到 50.8%。在讲英语的黑人和患者以及我们站点外的患者就诊期间观察到较低的给药率。结论 在我们的 PUC 中，单独面向提供者的干预措施并不能有效增加疫苗筛查和管理，但随着 DNV 的加入，观察到显着改善。需要未来的干预措施来解决差异。 需要进一步的调查来确定我们的结果在其他可以接种疫苗的 PUC 中是否具有可重复性。