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Pediatrics. 2016 Jun;137(6). pii: e20154603. doi: 10.1542/peds.2015-4603. Epub 2016 May 10.

Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial.

Author information

1
Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; lfu@childrensnational.org.
2
Goldberg Center for Community Pediatric Health and SciMetrika, LLC, Silver Spring, Maryland;
3
Goldberg Center for Community Pediatric Health and.
4
Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; AARP Public Policy Institute, Washington, District of Columbia;
5
Goldberg Center for Community Pediatric Health and The George Washington University School of Medicine, Washington, District of Columbia;
6
Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia;
7
Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California; and.
8
The George Washington University School of Medicine, Washington, District of Columbia;
9
Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; Division of General Pediatrics, University of Virginia School of Medicine, Charlottesville, Virgina.

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02432430.

PMID:
27244859
DOI:
10.1542/peds.2015-4603
[Indexed for MEDLINE]
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