380 - Expanding the Medical Home, Vaccinating Families in the Pediatric Emergency Department

Publication Number: 2369.380

Shannon H.. Baumer-Mouradian, Medical College of Wisconsin, Wauwatosa, WI, United States; Karen MacKinnon, Medical College of Wisconsin, Milwaukeee, WI, United States; Stacy Reid, Medical College of Wisconsin, Milwaukee, WI, United States; Tiffanie Renee. Schaefer, Children's Hospital of Wisconsin, Oconomowoc, WI, United States; Christopher M.. Harris, Children's Wisconsin, Milwaukee, WI, United States; Ashley SERVI, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Megan Ose, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Nitish Bangalore, Children's Wisconsin, Milwaukee, WI, United States; Wendy Krueger, Children's Wisconsin, Milwaukee, WI, United States; Amanda Wade, Children's Hospital of Wisconsin, Milwaukee, WI, United States; James Malloy, Children's Hospital of Wisconsin, Shorewood, WI, United States; Marisa Hoffman, Children's Hospital of Wisconsin, East Troy, WI, United States; Timothy Poulson, Children's Hospital of Wisconsin, Brookfield, WI, United States; Yilu Dong, Medical College of Wisconsin, Wauwatosa, WI, United States

Background: Pediatric Emergency Departments (PEDs) fulfill a critical need to provide a medical home for patients and families with limited access to medical care. To address declining vaccination rates in our community, we have sustained a successful influenza vaccination program for PED patients since 2018. Yet, family members of PED patients remain a missed opportunity for vaccination.

Objective: Systematically adapt a PED patient vaccine program to create a mobile, PED family vaccine clinic, optimize fit, & ensure core functions are maintained. Pilot the PED family vaccine clinic, assess clinical outcomes, and inform strategies for potential scale-up and sustainability.

Design/Methods: The adaptation process was guided by a Modified Approach to Intervention Mapping (IM-Adapt). An Adaptation Resource Team consisting of nursing, pharmacy, and PED provider leaders was formed. This team engaged in an iterative process of identifying and completing adaptations which were documented in the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME). Plan-do-study-act cycles were used to pilot the family vaccine clinic in a single, tertiary care PED, Mon.-Fri., 10am-6pm, for 10 weeks. Children and adults >6 months old, accompanying a lower acuity patient (triage level 2-5), who were unvaccinated for influenza this season, were eligible. Implementation outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, descriptive statistics, a mixed methods approach (observations, field logs, check-ins, and post-implementation surveys), and a financial analysis. A financial analysis estimated direct program margins by calculating reimbursement by financial class and accounting for vaccine and labor costs.

Results: Key adaptations included creating a new clinical workflow, EPIC workflow, staffing model, vaccine hesitancy training plan, and billing model. The family vaccine pilot began on 9/24/25. Table 1 describes the RE-AIM outcomes within the first 4 weeks of the 10-week pilot. In summary, 56% of ED families were screened for eligibility (n=1524 individuals), 74% were eligible, and 22% of those eligible were vaccinated (n=251). Table 2 describes the demographics of the vaccinated population (88% 18 years or older). Financial analysis suggests financial sustainability Table 3.

Conclusion(s): Preliminary findings suggest that the PED family vaccine clinic is both effective and financially sustainable, offering a promising model for expanding vaccination access among families in the emergency department setting.

Table 1 RE-AIM Implementation and Outcomes Measures
RE-

Aim: an implementation science framework used to inform intervention and implementation design, planning, and evaluation.
Data sources: A REDCap survey was completed by family vaccine clinic nurses to document the number of rooms approached, number of individuals in the room, vaccine eligibility of each individual, and nurse led vaccine counseling provided to families. A data dashboard in the electronic health record (EHR) captured the number of vaccines administered and demographics for the population vaccinated. Study leaders performed real-time observations, weekly check-ins, and reviewed field logs documented by family vaccine clinic nurses. The finance team performed a financial analysis to assess sustainability.

Table 2 Vaccinated Family Member Demographics
Demographics for the vaccinated population were obtained from a data dashboard for the pediatric emergency department family vaccine clinic in the electronic health record.

Table 3 Financial Analysis
A financial analysis estimated direct program margins by calculating reimbursement by financial class and accounting for vaccine and labor costs. Through week four of the ten-week pilot period, the program demonstrated positive direct margins. Extrapolation of these results over the complete ten-week timeframe of the program indicates financial self-sustainability. Sensitivity analyses were conducted to assess the robustness of these findings across key variables, including patient visit volume, reimbursement collection rates, and payer mix distribution. These analyses confirmed the program's strong likelihood of achieving financial viability.