Using the 4 Pillars™ Practice Transformation Program to Increase Adult Tdap Immunization in a Randomized Controlled Cluster Trial

Details

• Alternative Title:
  Vaccine
• Personal Author:
  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.
• 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.
  
  
• Subjects:
  Adult Adults Aged Aged, 80 And Over Article Diphtheria-Tetanus Vaccine Electronic Health Records Female Humans Immunization Immunization Programs Male Middle Aged Pennsylvania Pertussis Primary Health Care Program Evaluation Tdap Vaccine Tetanus Texas Vaccination

  More +
• 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
• Volume:
  34
• Issue:
  41
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:00f72f969ee836e36aaea6719ea4f9fa9ee4b9526231ab8a5d89ca76387c2ffe
• Download URL:
  https://stacks.cdc.gov/view/cdc/41479/cdc_41479_DS1.pdf
• File Type:
  [PDF - 625.93 KB ]