475 - Improving Nirsevimab Uptake in the Ambulatory Care Network

Publication Number: 475.5511

Ashley B. Stephens, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Connie Kostacos, Columbia University Vagelos College of Physicians and Surgeons, Cos Cob, CT, United States; Mariellen Lane, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Oscar A. Pena, NewYork-Presbyterian Hospital, New York, NY, United States; Allison Gorman, Weill Cornell Medicine, New York, NY, United States; Suzanne Friedman, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Theresa Hetzler, Weill Cornell Medicine, New York, NY, United States; Joanne Dempster, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Cindy Ippoliti, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Wanda J. Abreu, Columbia University Vagelos College of Physicians and Surgeons, NEW YORK, NY, United States; Melissa E. Glassman, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Kalpana Pethe, NewYork-Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States; Evelyn Berger-Jenkins, NYP-Columbia University Medical Center, New York, NY, United States; Melissa S. Stockwell, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Nirsevimab is a monoclonal antibody that prevents severe illness and hospitalization from Respiratory Syncytial Virus (RSV) in infants. It is a newly-approved product that was first recommended by the Advisory Committee on Immunization Practices in August 2023.

Objective: To increase the rate of uptake of nirsevimab for infants under 8 months old from a baseline of 0% to a goal of 60% between October 2023 and March 2024

Design/Methods: We implemented a nirsevimab quality improvement (QI) project in our urban academic-affiliated pediatric and family medicine outpatient practices serving predominantly publicly-insured patients in October 2023. Patients were considered eligible for nirsevimab if their birth parent did not receive RSV vaccine at least 2 weeks prior to birth. All eligible patients in the newborn nursery, NICU and outpatient sites were universally offered nirsevimab. Patients who received nirsevimab in the nursery, NICU, newborn clinic, or outpatient site were considered up to date.

QI interventions were based on perceived barriers including potential lack of acceptance by providers and families, supply chain concerns, and IT barriers. A key driver diagram was developed (Fig 1), and several interventions were implemented using a Plan, Do, Study, Act (PDSA) model.

Interventions focused on educating providers about nirsevimab through formal presentations and email reminders, educating patient families through a webinar and reminder outreach, creating clinical decision supports for providers such as integrating nirsevimab into the age-based orderset with options for dose based on weight, and addressing supply shortages by having both VFC and commercial supply, offering to patients regardless of insurance status and sharing doses among sites.

Results: Nirsevimab uptake increased from 0% to a cumulative average of 52% of eligible infants < 8 months throughout the October 2023-March 2024 season (Fig 2).

Conclusion(s): Coordination between the pharmacy staff, newborn medicine departments, newborn clinic, and ambulatory sites was necessary to ensure coverage of more than 50% of our patients under age 8 months in the first season of offering nirsevimab. This is compared to suboptimal rates across New York City which were an average of 6.6% coverage for the 2023-2024 season of infants under 8 months.

Further directions include developing a nirsevimab provider alert in the electronic medical record, re-educating providers about a quick link to the birth parent’s chart to verify nirsevimab eligibility, and implementing more regular outreach to patient families.

Figure 1: Nirsevimab Key Driver Diagram
Nirsevimab Key Driver Diagram used in the Ambulatory Care Network which includes 5 outpatient pediatric sites, 1 family medicine site, and newborn clinic

Figure 2: Nirsevimab Run Chart
Nirsevimab Run Chart showing the average uptake of nirsevimab between September 2023 and March 2024 in the Ambulatory Care Network which includes 5 outpatient pediatric sites, 1 family medicine site, and newborn clinic