Details:

Alternative Title:
J Am Geriatr Soc
Publisher's site:
http://dx.doi.org/10.1111/jgs.14451
Personal Author:
Zimmerman, Richard K. ; Brown, Anthony E. ; Pavlik, Valory N. ; Moehling, Krissy K. ; Raviotta, Jonathan M. ; ... More +
Zimmerman, Richard K. ; Brown, Anthony E. ; Pavlik, Valory N. ; Moehling, Krissy K. ; Raviotta, Jonathan M. ; Lin, Chyongchiou J. ; Zhang, Song ; Hawk, Mary ; Kyle, Shakala ; Patel, Suchita ; Ahmed, Faruque ; Nowalk, Mary Patricia Less -
Description:
BACKGROUND

Quality improvement in primary care has focused on improving adult immunization.

OBJECTIVES

Test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars™ Immunization Toolkit, to increase adult pneumococcal vaccination.

DESIGN

Randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013–5/31/2014) and a pre-post study in Year 2 (6/1/2014–1/31/2015) with data analyzed in 2016. Baseline year was 6/1/2012–5/31/2013. Demographic and vaccination data were derived from de-identified EMR extractions.

SETTING

25 primary care practices stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), randomized to receive the intervention in Year 1 (n=13) or Year 2 (n=12).

PARTICIPANTS

A cohort of 18,107 patients ≥65 years at baseline with a mean age of 74.2 years; 60.7% were women, 16.5% were non-white and 15.7% were Hispanic.

INTERVENTION

The Toolkit, provider education, and one-on-one coaching of practice-based immunization champions. Outcome measures were 23-valent pneumococcal polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine (PCV) rates and percentage point (PP) changes.

RESULTS

In the RCCT, all intervention and control groups had significantly higher PPSV vaccination rates with average increases ranging from 6.5–8.7 PP (P<0.01). The intervention was not related to higher likelihood of PPSV vaccination. In the Year 2 pre-post study, the likelihood of PPSV and PCV vaccination was significantly higher in the active intervention sites than the maintenance sites in Pittsburgh, but not in Houston.

CONCLUSION

In a randomized controlled cluster trial, both intervention and control groups increased PPSV among adults ≥65 years. In a pre-post study, private primary care practices using the 4 Pillars™ Immunization Toolkit significantly improved PPSV and PCV uptake compared with practices that were in the maintenance phase of the study.


Subject:
[+]
Aged
Article
Evidence-Based Practice
Female
Health Promotion
Humans
Male
Patient Education As Topic
Pneumococcal Vaccines
Primary Health Care
Vaccination
Vaccines, Conjugate

Source:
J Am Geriatr Soc. 65(1):114-122.
Pubmed ID:
27755655
Pubmed Central ID:
PMC5258838
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:d453011fb9d43ab2ddd45cecf70f851a37a83cf6041ba3a4936cf3a54a73a654
File Type:

Supporting Files

• 	NIHMS793337-supplement-Supp_Table_S1.docx	docx
  	nihms793337.nxml	xml
  	nihms793337f1.gif	gif
  	nihms793337f1.jpg	jpeg
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