UC Irvine

Purpose: To assess provider knowledge and confidence in screening children less than 8 months of age for Respiratory Syncytial Virus (RSV) prophylaxis and assess acceptance rates pre- and post-multilevel provider educational intervention in a pediatric primary care clinic. Background Respiratory syncytial virus (RSV) occurs in 90% of children less than 2 years of age and is the leading cause of hospitalizations in children under 1 year of age (50,000-100,000 per year). RSV is a common respiratory virus, with Infants and young children < 8 months of age at greatest risk for severe illness. The Center for Disease Control (CDC) created new RSV prophylaxis guidelines in 2022 to include either maternal vaccination or infant prophylaxis with early data showing it is 80-90% effective in preventing RSV hospitalization. There is still a significant gap in RSV acceptance rates nationally with only 35% of pregnancy women and 40% of infants having received it. This gap can be improved through provider education on screening for eligibility. Methods: Using the IOWA model of Evidence-Based Practice, a multilevel provider education intervention was employed based on the CDC RSV Clinical Practice Guidelines 2022 (e.g., Inservice, screening algorithm and script, CDC RSV handout for caregivers, and “dot phrase” reminder for provider notes). A pre- and post-education survey assessed provider knowledge, and confidence in RSV screening. Screening and RSV acceptance rates were monitored over 3 months both pre- and post-intervention. Results Out of 8 providers (MD/NP), 63% responded to the pre- and post- education survey. Providers had good knowledge of RSV prophylaxis screening but lacked confidence in where to document in the EHR. Number of children screened by providers improved by 23% (860 [69%] vs. 1080 [92%]) pre- and post-intervention. Despite improved screening, in children eligible, increase declines by 16% (119 [47%] vs. 154 [63%]) pre- and post-intervention. Reasons for declines post-intervention, 93 (60%) unspecified, 22 (14%) need more information, and 16 (10%) family declines all vaccinations. Conclusions and Future Implications: RSV prophylaxis acceptance remains a concern in pediatrics despite improved provider confidence and increased screening efforts. Future projects should investigate decline reasons and develop targeted parent interventions.