202 - A QI approach to vaccine hesitancy in the context of increasing vaccine misinformation and public distrust.

Publication Number: 3194.202

Alexandra Golden, Weill Cornell Medicine, New York City, NY, United States; Anoush Calikyan, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Leizer Steppa, NewYork-Presbyterian Komansky Children’s Hospital, New york, NY, United States; William Warren, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Oscar A. Pena, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Karen Acker, Weill Cornell Medicine, New York, NY, United States; Sallie R. Permar, Weill Cornell Medicine, New York, NY, United States; Snezana Nena Osorio, Weill Cornell Medicine, New York, NY, United States; Ashley Stephens, Columbia University Vagelos College of Physicians and Surgeons, Northport, NY, United States; Allison Gorman, Weill Cornell Medical College, new York, NY, United States

Background: Suboptimal vaccination rates are leading to resurgence of once rare diseases. This decline is multifactorial in nature including a growing problem of vaccine hesitancy. A similar trend has been noted in our urban academic clinic.

Objective: We aimed to increase the percentage of children who are up to date (UTD) with Healthcare Effectiveness Data and Information Set (HEDIS) vaccine combination 3 by 24 months of age from 72% to 90% by December 2026.

Design/Methods: This ongoing observational QI study, conducted from December 2023 to August 2025 at an urban, predominantly publicly insured pediatric clinic within a tertiary academic center, uses sequential experimentation. A resident-led interdisciplinary team (faculty, nurses, technicians, parents, QI specialist) applied the Model for Improvement to identify key drivers and define measures: % of children aged 24 -35 months receiving HEDIS Combo 3 vaccines by 24 months (outcome), % of providers trained in motivational interviewing (MI) and % of missed immunization opportunities (process), and well-child visit volume due to a potential dampening effect on parental incentive to return for routine care (balancing). Interventions included resident education on affirmative language and MI, electronic health record (EHR) modifications to document vaccine acceptance/declination, updated attribution logic (≥2 in-person visits OR 1 well child check in 18 months), and standardized written materials for hesitant caregivers (Figure 1). Five PDSA cycles were tested. Data were collected via EHR and analyzed using Run chart and Shewhart charts with run chart rules and API rules to detect a signal of change and special cause variation respectively.

Results: HEDIS combo 3 rates continued to decline from 92% to 72 % despite series of interventions (Figure 2). We decreased the percentage of missed opportunities to immunize from 14.5% to 0.7% (special cause; out of 321 visits reviewed, only 27 missed opportunities were identified). There was no change in the number of children presenting for well childcare in our population due to potential dampening effect on parental incentive to return for well-child care visits (Figure 3).

Conclusion(s): In the setting of overall erosion of trust in vaccines at federal and community levels and decreasing missed opportunities to vaccinate, these interventions did not prevent a decline in vaccination rates in young children in our population. Increased use of evidence-based interventions and new strategies at the pediatrician, community, and national level will be needed to prevent outbreaks and deaths from preventable childhood disease.

Figure 1
Key Driver Diagram

Figure 2
Steady decline in HEDIS Combo 3 Immunization from 92% to 72% despite multiple interventions.


Figure 3
No change in the median number of well child visits in children 23-35 months old due to a potential dampening effect on parental incentive to return for routine care