Innovative hybrid approach increases vaccinations and primary care visits during pandemic

Reviewed by Emily Henderson, B.Sc.Nov 2 2020

Nemours Children's Health System increased patient immunizations by 4.6% from January - September 2020, compared with the same period in 2019, through an innovative hybrid approach to care using both in-person and telemedicine, according to new data presented today at the Children's Hospital Association's 2020 Annual Leadership Conference.

Between March and May, COVID-19 forced the cancellation of 48% of primary care visits and 28.5% of immunizations, but the multi-state health system was able to ensure the health needs of its 180,000 primary care patients by assembling a multidisciplinary team to improvise new methods to assure delivery of this crucial preventive care.

Children's well-care has an enormous impact on their growth and development, and staying on track with their immunizations keeps us all safe from vaccine-preventable illnesses. The immunization rates we are seeing are a great sign of the impact we're having, especially considering the overall national declines that have been reported in immunizations among adolescents and children since the pandemic began."

Jonathan Miller, MD, author of the study and medical director of Nemours' Value-Based Service Organization

After experiencing the sharp post-COVID decline, Nemours brought together a multi-disciplinary team representing expertise in population health, data analytics, and medical management to develop rapid, innovative changes to the health system's primary care sites in Delaware, Pennsylvania, and Florida. The team used four primary strategies:

1. Cohorting patients and practices to separate sick and well children to limit exposure to illnesses;

2. Harnessing telemedicine to meet immediate needs;

3. Using tents for immunizations and limited physical exams;

4. Calling families' homes to screen for social determinants of health that may be impacting their overall well-being.

As a result of these changes, Nemours increased overall child immunizations by 4.6% over 2019 rates, provided more than 36,000 primary care telemedicine visits, and cared for nearly 10,000 children using "tele-well" visits that used telemedicine and limited in-person care. Of nearly 20,000 physicals canceled due to the pandemic, 85% have been completed or rescheduled.

"Given all of the hurdles children and families have faced in receiving preventative care this year, we are heartened by the level of care we were able to bring to our communities," said Thomas Lacy, MD, an author of the study and division chief for Nemours Primary Care and Urgent Care in Florida. "COVID-19 presented enormous obstacles that have required ingenuity to continue to meet the needs of children."