Text Message Quality Improvement Intervention Improves Influenza Vaccination Rate Among Pediatric Patients With Asthma

Friday, 28 July 2017

Elizabeth Sloand, PhD
Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
Augusta MacQueen, BSN
Labor and Delivery, George Washington University Hospital, Washington, DC, USA
Sarah Polk, MD
Pediatrics, Johns Hopkins Univerisity School of Medicine, Baltimore, MD, USA
Annie Holm, MSN
Johns Hopkinsn School of Nursing, Baltimore, MD, USA

Background: The Centers for Disease Control (CDC) and the World Health Organization (WHO) recognize that children with asthma are at an increased risk of severe complications due to influenza infection. The CDC highly recommends that all children with asthma, 6 months and older, receive an annual influenza vaccine. Clinicians are challenged to educate families about the recommendations and insure that these high risk children are vaccinated each year.

Methods: For the 2015-2016 influenza season (Year 1), a reminder text message campaign was implemented at an ambulatory pediatric clinic to improve influenza vaccination adherence rates among children with asthma. The majority of the clinic’s patients have public insurance and are Latino children with immigrant parents. Using the electronic medical record, a list of children with asthma and their family’s phone number was generated. A three-part text message in English or Spanish was sent with information about the vaccine, a link to an informational video for parents, and instructions for making an appointment to get the vaccine. The Year 1 campaign was evaluated and revised accordingly. The text-based campaign was relaunched for the 2016-2017 influenza season, Year 2, which will include October 2016 to April 2017. For Year 2, the text message was clarified and the text response options were simplified. Follow up phone calls were made as needed. Responses for each year were tallied. Results for both years were analyzed and compared.

Results: For Year 1, text messages were sent to 381 households, representing 399 clinic patients. The response rate was 11.5%. For Year 2, text messages were sent to 441 households. Preliminary results indicate an increase in both response rates and influenza vaccination rates. These early results from Year 2 will be further refined and analyzed in order to further improve the influenza vaccine program for next year.

Conclusions: The text message project showed that family responses and influenza vaccine rate improved from Year 1 to Year 2. This project sets the stage for future quality improvement research on text message reminder/recall systems to increase annual influenza vaccination rates in pediatric patients with asthma. Such text message interventions may increase population/family engagement and influenza vaccination rates, ultimately decreasing preventable, severe health complications in children with asthma. This is particularly important because of the inclusion of minority immigrant children, an under-represented population that is not routinely included in health outreach efforts.