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Tennessee's 3-Star Report: Using Available Data Systems to Reduce Missed Opportunities to Vaccinate Preteens.

ABSTRACT: All preteens should receive tetanus-diphtheria-pertussis vaccine (Tdap), quadrivalent meningococcal vaccine (Men-ACWY), and the human papillomavirus (HPV) cancer vaccine series. In Tennessee, HPV vaccination rates have stagnated at low levels for a decade. Three fundamental strategies to reduce missed opportunities for immunization include administering all recommended vaccines at the same visit, making strong recommendations for vaccines, and auditing and feedback. In Tennessee, during each summer, a surge of preteens visit local health departments (LHDs) to receive a required Tdap vaccine before entering seventh grade, presenting an opportunity to administer Men-ACWY and HPV. The Tennessee Immunization Program (TIP) coined the term "3-Star visit" for such encounters and developed a monthly report to track them using data from the Patient Tracking Billing Management Information System (PTBMIS) used by LHDs across Tennessee. Implementation of this quality improvement report has correlated with a substantial increase in 3-Star visits from 2013 to 2016, particularly during the summer months.

SUBMITTER: Moore KL

PROVIDER: S-EPMC5138065 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Tennessee's 3-Star Report: Using Available Data Systems to Reduce Missed Opportunities to Vaccinate Preteens.

Moore Kelly L KL Fankhauser Melissa K MK Hull Pamela C PC

Biomedical informatics insights 20161204 Suppl 2

All preteens should receive tetanus-diphtheria-pertussis vaccine (Tdap), quadrivalent meningococcal vaccine (Men-ACWY), and the human papillomavirus (HPV) cancer vaccine series. In Tennessee, HPV vaccination rates have stagnated at low levels for a decade. Three fundamental strategies to reduce missed opportunities for immunization include administering all recommended vaccines at the same visit, making strong recommendations for vaccines, and auditing and feedback. In Tennessee, during each sum ...[more]

PMID: 27980415

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Project description:BACKGROUND:Adult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates. METHODS:This prospective interventional before-and-after non-randomized study was conducted through the American Academy of Family Physicians National Research Network with 43 primary care physicians from a large multi-specialty healthcare organization (multicomponent intervention group n?=?23; comparator group n?=?20) in the United States. The multicomponent intervention included provider reminders, quarterly provider-level performance reports, provider education, patient visual aid materials, and standing orders on adult pneumococcal, influenza, and zoster immunizations. We assessed individual and comparative provider-level vaccination rates and missed opportunities detailing concordance with targets established by Healthy People 2020 for pneumococcal, influenza, and zoster immunizations. RESULTS:Vaccination rates increased after 12?months in intervention and comparator groups respectively for: a). influenza from 44.4?±?16.7 to 51.3%?±?12.9% (by 6.9 percentage points, p?=?0.001) and from 35.1?±?19.1 to 41.3%?±?14.2%, (by 6.2 percentage points, p?=?0.01); b). pneumococcal vaccinations in older adults from 62.8?±?17.6 to 81.4%?±?16.6% (by 18.6 percentage points, for p?<?0.0001) and from 55.9?±?20.0 to 72.7%?±?18.4% (by 16.7 percentage points, p?<?0.0001); and c). zoster from 37.1?±?13.4 to 41.9%?±?13.1% (by 4.8 percentage points, p?<?0.0001) and from 35.0?±?18.7 to 42.3%?±?20.9% (7.3 percentage points, p?=?0.001). Pneumococcal vaccinations in adults at risk did not change from baseline in intervention group (35.7?±?19.6 to 34.5%?±?19.0%, p?=?0.3) and improved slightly in comparator group (24.3?±?20.1 to 28.2%?±?20.0%, p?=?0.003). Missed opportunities reduced after 12?months, most noticeably, for: a). for influenza from 57.7 to 48.6% (by 9.1 percentage points, p?<?0.0001) and from 69.7 to 59.6% (by 10.1 percentage points, p?<?0.0001); b). pneumococcal vaccinations in older adults from 18.1 to 11.5% (by 6.6 percentage points p?<?0.0001) and from 24.6 to 20.4% (by 4.3 percentage points, p?<?0.0001) in intervention and comparator groups respectively. CONCLUSIONS:Multicomponent interventions show promise in improving vaccination rates and reducing missed opportunities in older adults for pneumococcal and zoster vaccines and vaccination against influenza. Provider reminders remain the most effective strategy when delivered either as a component of these interventions or alone.

Project description:An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine.Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n?=?13) or control (n?=?12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions.A cohort of 70,549 adults seen in their respective practices (n?=?24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were Hispanic. After one year, both intervention and control arms significantly (P?<?0.001) increased influenza vaccination, with average increases of 2.7 to 6.5 percentage points. In regression analyses, likelihood of influenza vaccination was significantly higher in sites with lower percentages of patients with missed opportunities (P?<?0.001) and, after adjusting for missed opportunities, the intervention further improved vaccination rates in Houston (lower baseline rates) but not Pittsburgh (higher baseline rates). In the follow-up intervention, the likelihood of vaccination increased for both intervention sites and those that reduced missed opportunities (P?<?0.005).Reducing missed opportunities across the practice increases likelihood of influenza vaccination of adults. The 4 Pillars™ Practice Transformation Program provides strategies for reducing missed opportunities to vaccinate adults.This study was registered as a clinical trial on 03/20/2013 at ClinicalTrials.gov, Clinical Trial Registry Number: NCT01868334 , with a date of enrollment of the first participant to the trial of April 1, 2013.

Dataset Information

Tennessee's 3-Star Report: Using Available Data Systems to Reduce Missed Opportunities to Vaccinate Preteens.

Publications

Tennessee's 3-Star Report: Using Available Data Systems to Reduce Missed Opportunities to Vaccinate Preteens.

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