| Description |
Background: Children in foster care face significant barriers to timely vaccinations, resulting in higher rates of delayed immunizations compared to their non-foster peers. These barriers include incomplete medical records, operational challenges, and complex health needs among foster youth. Despite guidelines from the Department of Child and Family Services (DCFS) allowing clinics to follow CDC vaccination protocols, procedural inefficiencies persist due to the lack of a standardized workflow. This leads to delays in care, increased staff burden, and missed vaccination opportunities. Local Problem: At the University of Utah South Main Foster Care Clinic, childhood immunization rates range from 67.8% to 78.6%, falling below established public health goals. The current vaccination reconciliation process is time-intensive, requiring substantial staff effort and coordination with DCFS, which historically experiences barriers with limited bandwidth and procedural challenges. Challenges include incomplete records in Utah's Statewide Immunization Information System and delays in obtaining consent for routine vaccinations. Methods: This quality improvement project utilized a mixed methods approach to develop and implement a standardized vaccination reconciliation workflow over three months. A baseline assessment included stakeholder interviews, a SWOT analysis, and an evaluation of existing clinical algorithms. Quantitative measures tracked time spent on reconciliation, frequency of reconciliation, and missed vaccination opportunities. Qualitative data were collected through semi-structured interviews with clinic staff and DCFS representatives to assess feasibility, usability, and acceptability. Interventions: A formal standardized vaccination workflow was designed to streamline the reconciliation process for children in foster care. Key components included a detailed flowsheet that considered the DCFS schedule and comprehensive training sessions for clinic staff. The intervention aimed to reduce delays by improving stakeholder communication and staff confidence using CDC guidelines for vaccination recommendations. Results: The intervention resulted in significant improvements in vaccination reconciliation processes. The time spent on reconciliation decreased by 33.33%, from 45 to 30 minutes per patient, which allowed staff to allocate more time to other critical tasks. Missed vaccination opportunities were reduced by 60%, dropping from ten to four, ensuring more foster children received timely immunizations. Additionally, the frequency of reconciliation per patient increased from two to five times, improving the consistency and accuracy of vaccination tracking. Qualitative feedback highlighted enhanced collaboration between clinic staff and DCFS caseworkers, with participants noting improved communication and a cultural shift toward proactive care. Staff expressed increased confidence in offering vaccines, supported by enhanced workflow usability. Conclusion: Implementing a standardized vaccination workflow improved efficiency, reduced missed opportunities for vaccination, and strengthened inter-agency communication at the University of Utah South Main Foster Care Clinic. These findings highlight the feasibility and acceptability of structured interventions in addressing healthcare disparities for foster youth. Future efforts should focus on scaling the intervention statewide, incorporating technological solutions for record-sharing, and addressing systemic barriers such as policy constraints and resource limitations. This project underscores the importance of tailored QI initiatives to improve health outcomes for vulnerable populations like foster children. |
