Changes in Clinic Vaccination Coverage After Institution of Measurement and Feedback in 4 States and 2 Cities

LeBaron, Charles W.; Mercer, Joan; Massoudi, Mehran S.; Dini, Eugene F.; Stevenson, John; Fischer, Wayne M.; Loy, Herbert; Quick, Lori Stonehocker; Warming, John C.; Tormey, Pat; desVignes-Kendrick, Mary

doi:10.1001/archpedi.153.8.879

Cited by 44 publications

(24 citation statements)

References 14 publications

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“…In this trial, we used both strategies, which were associated with 5% to 6% higher receipt of adequate immunizations and 7% to 8% higher receipt of WCVs in the intervention arms. This finding is consistent with previous effects for AFIX-based interventions 25 and is at the lower end of published effects for reminder/recall-based interventions. 21 What were the reasons for the modest effect seen in this trial?…”

Section: Commentsupporting

confidence: 92%

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population

Hambidge

Davidson²,

Phibbs³

et al. 2004

Arch Pediatr Adolesc Med

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This multimodal intervention produced a small increase in the number of childhood immunizations delivered. However, patient- and clinic-based methods did not lead to significant increases in WCV or immunization up-to-date rates after controlling for other factors. Methods found in some settings to increase immunization up-to-date rates may not be as effective in a population of inner-city socioeconomically disadvantaged children.

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Section: Commentsupporting

confidence: 92%

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population

Hambidge

Davidson²,

Phibbs³

et al. 2004

Arch Pediatr Adolesc Med

Self Cite

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“…These incremental improvements are similar to those attained in early childhood AFIX programs, but unlike previous studies, we did not find that such differences persisted over time. 3 At 1 year, vaccine coverage levels in the intervention arms were similar to the control arm. This finding may indicate that vaccine providers in the intervention arms were able to initiate, but not sustain, quality improvement efforts.…”

Section: Discussionmentioning

confidence: 86%

“…7 It had power to detect a change in vaccine coverage of ∼2 percentage points, which we considered adequate given that AFIX consultations have been shown to increase early childhood vaccination by 4 to 7 percentage points. 3,4 The North Carolina Division of Public Health institutional review board approved the study.…”

Section: Clinic Selectionmentioning

confidence: 99%

“…2,3 Delivered by state and regional health departments to vaccine providers, AFIX consists of a brief consultation in which an immunization specialist evaluates a clinic' s vaccine coverage levels and works with providers to set goals for improvement. For early childhood vaccines, this low-cost strategy of "assessment and feedback" increases coverage by 4 to 7 percentage points 3,4 and has received the Community Preventive Services Task Force's strongest recommendation for use. 5 The CDC supports AFIX programs in all 50 states, and it encourages health departments to deliver early childhood AFIX consultations to at least onequarter of federally funded vaccine providers each year.…”

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confidence: 99%

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Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.WHAT THIS STUDY ADDS: AFIX consultations achieved short-term gains in coverage for 11-to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. abstract OBJECTIVES: To assess the effectiveness of in-person and webinardelivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage. METHODS:We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state' s immunization registry provided vaccine coverage data for younger patients (ages 11-12 years) and older patients (ages 13-18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines ($1 dose, females only). RESULTS:At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P ..05).CONCLUSIONS: Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine. Pediatrics 2014;134:e346-e353 AUTHORS:

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“…15,16 Assessment, Feedback, Incentives, and Exchange (AFIX), a program designed to provide intervention and education to immunization providers, has been shown to help improve childhood immunization rates, and providing AFIX to adolescent providers could be a cost-effective way to educate providers and increase adolescent vaccination rates. 17 Unlike Tdap and MCV4, which have been required since the 2008-2009 school year, North Dakota does not require HPV4 at middle school entry. 18 School entry requirements have been shown to be effective at increasing coverage of required vaccines shortly after their adoption and could be an effective way to increase the number of females vaccinated with HPV4, as they have with the hepatitis B vaccine.…”

Section: Discussionmentioning

confidence: 99%

Using the North Dakota Immunization Information System to Determine Adolescent Vaccination Rates and Uptake

LoMurray

Sander

2011

Public Health Rep

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Objectives. We described the uptake and coverage rates of meningococcal conjugate vaccine (MCV4); tetanus-diphtheria-acellular pertussis vaccine (Tdap); and quadrivalent human papillomavirus vaccine (HPV4) in North Dakota using the North Dakota Immunization Information System (NDIIS).Methods. We analyzed all available MCV4, Tdap, and HPV4 doses given after vaccine licensure and through December 31, 2009, obtained from the NDIIS to identify trends and patterns in vaccine administration. We analyzed all data by administration date, age group, and health-care provider type. We also calculated missed opportunities to complete all recommended vaccines among vaccinated adolescents.Results. For adolescents aged 13-17 years, 69.2% had $1 dose of Tdap and 62.8% had $1 dose of MCV4. Of females aged 13-17 years, 42.8% initiated the HPV4 vaccination series and 24.9% received $3 HPV4 doses. Only 48.7% of males aged 13-17 years received both Tdap and MCV4 at the same visit, and only 11.5% of females aged 13-17 years received Tdap, MCV4, and HPV4 doses at the first visit.Conclusions. The NDIIS is useful in tracking adolescent vaccine uptake. The immunization rates for all three routinely recommended adolescent vaccines are rising in North Dakota, although at different paces. Providers should be educated about the importance of not missing opportunities to vaccinate, and school-based vaccination clinics should be used to reach adolescents who are less likely to have preventive care visits.

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Changes in Clinic Vaccination Coverage After Institution of Measurement and Feedback in 4 States and 2 Cities

Cited by 44 publications

References 14 publications

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population

Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

Using the North Dakota Immunization Information System to Determine Adolescent Vaccination Rates and Uptake

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