Article2016

Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial

Linda Y. Fu · Kathleen Zook · Janet A. Gingold · Catherine Wilson Gillespie · Christine Briccetti · Denice Cora‐Bramble +3 more

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Vaccine Coverage and Hesitancy Primary Care and Health Outcomes Health Policy Implementation Science

Abstract

OBJECTIVE: New emphasis on and requirements for demonstrating health care quality have increased the need for evidence-based methods to disseminate practice guidelines. With regard to impact on pediatric immunization coverage, we aimed to compare a financial incentive program (pay-for-performance [P4P]) and a virtual quality improvement technical support (QITS) learning collaborative. METHODS: This single-blinded (to outcomes assessor), cluster-randomized trial was conducted among unaffiliated pediatric practices across the United States from June 2013 to June 2014. Practices received either the P4P or QITS intervention. All practices received a Vaccinator Toolkit. P4P practices participated in a tiered financial incentives program for immunization coverage improvement. QITS practices participated in a virtual learning collaborative. Primary outcome was percentage of all needed vaccines received (PANVR). We also assessed immunization up-to-date (UTD) status. RESULTS: Data were analyzed from 3,147 patient records from 32 practices. Practices in the study arms reported similar QI activities (∼6 to 7 activities). We found no difference in PANVR between P4P and QITS (mean ± SE, 90.7% ± 1.1% vs 86.1% ± 1.3%, P = 0.46). Likewise, there was no difference in odds of being UTD between study arms (adjusted odds ratio 1.02, 95% confidence interval 0.68 to 1.52, P = .93). In within-group analysis, patients in both arms experienced nonsignificant increases in PANVR. Similarly, the change in adjusted odds of UTD over time was modest and nonsignificant for P4P but reached significance in the QITS arm (adjusted odds ratio 1.28, 95% confidence interval 1.02 to 1.60, P = .03). CONCLUSIONS: Participation in either a financial incentives program or a virtual learning collaborative led to self-reported improvements in immunization practices but minimal change in objectively measured immunization coverage.

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References

1994General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)2009A Strategy for Health Care Reform — Toward a Value-Based System 2011IMMUNIZATION OF HEALTH-CARE PERSONNEL: RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)2000Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization 2017General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)2008Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis 2015National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2014 2012Recommended Adult Immunization Schedule: United States, 2012

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