Details:

Alternative Title:
Vaccine
Publisher's site:
http://dx.doi.org/10.1016/j.vaccine.2016.07.053
Personal Author:
Nowalk, Mary Patricia ; Lin, Chyongchiou J. ; Pavlik, Valory N. ; Brown, Anthony E. ; Zhang, Song ; ... More +
Nowalk, Mary Patricia ; Lin, Chyongchiou J. ; Pavlik, Valory N. ; Brown, Anthony E. ; Zhang, Song ; Moehling, Krissy K. ; Raviotta, Jonathan M. ; South-Paul, Jeannette E. ; Hawk, Mary ; Ricci, Edmund M. ; Middleton, Donald B. ; Lorick, Suchita A. ; Ahmed, Faruque ; Zimmerman, Richard K. Less -
Description:
Introduction

National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars™ Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the Program, provider education, and one-on-one coaching of practice-based immunization champions.

Methods

25 primary care practices participated in a randomized controlled cluster trial in Year 1 (6/1/2013–5/31-2014) and a pre-post study in Year 2 (6/1/2014–1/31/2015). Baseline year was 6/1/2012–5/31/2013, with data analyzed in 2016. Demographic and vaccination data were derived from de-identified electronic medical record (EMR) extractions. The primary outcomes were vaccination rates and percentage point (PP) changes/year.

Results

The cohort consisted of 70,549 patients ≥ 18 years who were seen in the practices ≥ 1 time each year, with a baseline mean age = 55 years; 35% were men; 56% were non-white; 35% were Hispanic and 20% were on Medicare. Baseline vaccination rate averaged 35%. In the Year 1 RCCT, cumulative Tdap vaccination increased significantly in both intervention and control groups; in both cities, the percentage point increases in the intervention groups (7.7 PP in Pittsburgh and 9.9 PP in Houston) were significantly higher (P<0.001) than in the control groups (6.4 PP in Pittsburgh and 7.6 PP in Houston). In the Year 2 pre-post study, in both cities, active intervention groups increased rates significantly more (6.2 PP for both) than maintenance groups (2.2 PP in Pittsburgh and 4.1 PP in Houston; P<0.001).

Conclusions

An intervention that includes the 4 Pillars™ Practice Transformation Program, staff education and coaching is effective for increasing adult Tdap immunization rates within primary care practices.


Subject:
[+]
Adult
Aged
Aged, 80 And Over
Article
Diphtheria-Tetanus Vaccine
Electronic Health Records
Female
Humans
Immunization Programs
Male
Middle Aged
Primary Health Care
Program Evaluation
Vaccination

Source:
Vaccine. 34(41):5026-5033
Pubmed ID:
27576073
Pubmed Central ID:
PMC5036274
Document Type:
Journal Article
Funding:
U01 IP000662/IP/NCIRD CDC HHS/United States ; UL1 RR024153/RR/NCRR NIH HHS/United States ; UL1 TR000005/TR/NCATS NIH HHS/United States
U01 IP000662/IP/NCIRD CDC HHS/United States ; UL1 RR024153/RR/NCRR NIH HHS/United States ; UL1 TR000005/TR/NCATS NIH HHS/United States Less -
Place as Subject:
Pennsylvania ; Texas
Pennsylvania ; Texas Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:00f72f969ee836e36aaea6719ea4f9fa9ee4b9526231ab8a5d89ca76387c2ffe
File Type:

Supporting Files

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