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Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial
Linda Y Fu1, Kathleen Zook2, Janet A Gingold3
1Goldberg 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.
Pediatrics
|June 1, 2016
Summary
Financial incentives (pay-for-performance) and virtual learning collaboratives showed no significant difference in improving pediatric immunization coverage, despite self-reported practice improvements.
Area of Science:
- Health Services Research
- Pediatric Health
- Quality Improvement
Background:
- Demonstrating healthcare quality requires evidence-based dissemination of practice guidelines.
- Pediatric immunization coverage is a key area for quality improvement initiatives.
Purpose of the Study:
- To compare the effectiveness of a pay-for-performance (P4P) financial incentive program versus a virtual quality improvement technical support (QITS) learning collaborative on pediatric immunization coverage.
Main Methods:
- A single-blinded, cluster-randomized trial involving 32 pediatric practices in the US (June 2013-June 2014).
- Practices were assigned to either P4P or QITS intervention, both receiving a Vaccinator Toolkit.
- Primary outcome: percentage of all needed vaccines received (PANVR); secondary outcome: immunization up-to-date (UTD) status.
Main Results:
- No significant difference in PANVR between P4P and QITS groups (90.7% vs 86.1%).
- No significant difference in the odds of being UTD between study arms (adjusted odds ratio 1.02).
- The QITS arm showed a significant increase in adjusted odds of being UTD over time (adjusted odds ratio 1.28, P = .03).
Conclusions:
- Both P4P and QITS interventions led to self-reported improvements in immunization practices.
- Objective measures of pediatric immunization coverage showed minimal change with either intervention.
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