title: Combining evidence and diffusion of innovation theory to enhance influenza immunization.
abstract: BACKGROUND
  Children and adolescents with chronic conditions such as asthma, diabetes, and HIV are at high risk of influenza-related morbidity, and there are recommendations to immunize these populations annually. At Cincinnati Children's Hospital Medical Center, the influenza immunization rate increased to 90.4% (5% declined) among 200 patients with cystic fibrosis (CF). Diffusion of innovation theory was used to guide the design and implementation of spread to other clinics.
  
  
  METHODS
  The main intervention strategies were: (1) engagement of interested, nurse-led teams, (2) A collaborative learning session, (3) A tool kit including literature, sample goals, reminder postcards, communication strategies, and team member roles and processes, (4) open-access scheduling and standing orders (5) A simple Web-based registry, (6) facilitated vaccine ordering, (7) recall phone calls, and (8) weekly results posting.
  
  
  RESULTS
  Clinic-specific immunization rates ranged from 32.7% to 92.8%, with the highest rate reported in the CF clinic. All teams used multiple strategies; with six of the seven using four or more. Overall, 60.0% (762/1,269) of the population was immunized. Barriers included vaccine shortages, lack of time for reminder calls, and lack of physician support in one clinic.
  
  
  CONCLUSIONS
  A combination of interventions, guided by evidence and diffusion of innovation theory, led to immunization rates higher than those reported in the literature.
authors.affiliation: Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, USA. maria.britto@cchmc.org
authors.forename: Maria T
authors.initials: MT
authors.lastname: Britto
authors.forename: Geralyn M
authors.initials: GM
authors.lastname: Pandzik
authors.forename: Connie S
authors.initials: CS
authors.lastname: Meeks
authors.forename: Uma R
authors.initials: UR
authors.lastname: Kotagal
mesh_terms: D000293:Adolescent; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications; D004059:Diffusion of Innovation; D004282:Documentation; D006293:Health Promotion / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006785:Hospitals, University / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D009726:Nurses / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012307:Risk Factors
chemical_list: D007252:Influenza Vaccines