AAP chapters have found that state immunization information systems (IISs) can be a valuable component of quality improvement (QI) projects aimed at increasing vaccination rates.
IISs (registries) can assist in determining when vaccinations are due, sending vaccination reminder/recall messages, identifying populations at high risk for vaccine-preventable diseases and targeting interventions and resources efficiently.
Since 2015, almost all 59 U.S. AAP chapters have implemented at least one QI project through the Hub and Spoke Initiative Focused on Improving HPV Vaccination Rates. These projects have consistently led to increases in rates of HPV vaccine series initiation and completion.
As part of the initiative, the Indiana Chapter hosted a series of provider learning sessions on how to raise adolescent vaccination rates in pediatric practice by making a strong vaccine recommendation. Sessions included instruction from a pediatric infectious disease specialist.
The chapter worked with the Indiana State Department of Health (ISDH) to provide each attendee with the HPV vaccination rate in her/his practice at the time of the first learning session.
“Most participants had believed their rates to be higher than those actually documented in the state IIS,” said Christopher Weintraut, J.D., chapter executive director. “When they saw their own data, they said to themselves, ‘I’m part of the problem!’”
Six months after the first learning session, the ISDH re-pulled data from the state IIS for each attendee. Almost every attendee saw an increase in vaccination rates.
The average increase in initiation of the HPV series for all attendees was more than 6 percentage points (from 67% at baseline to 74% at the six-month follow up). One attendee’s practice raised the series initiation rate by 20 percentage points (from 51% to 71%).
Weintraut said the IIS data motivated some participants to discuss HPV vaccination issues with their colleagues in an effort to change their practice culture. In addition, participants were able to see their vaccination rates without having to pull charts themselves.
“Working with ISDH was a very positive experience and having access to Indiana’s immunizations registry made pulling those numbers a painless experience,” Weintraut said. “As an additional benefit, it helped our chapter foster new relationships with the immunization division of our health department.”
Several other chapters also are using IIS data to improve adolescent vaccination rates through the Adolescent Vaccinations and Wellness Grant Program for Chapters.
Examples include:
The Kansas Chapter partnered with the Kansas Immunization Program to provide a webinar demonstrating how being part of the Kansas Immunization Registry can help with tracking and immunization reminder/recall.
As part of a half-day seminar offered by the Texas Chapter, a representative from the Texas Department of State Health Services Infectious Disease Control Unit presented best practices for increasing HPV immunization rates, including using an IIS for immunization tracking and reminder/recall functions.
Practices participating in the Georgia Chapter program used reports from the state IIS to call patients and schedule vaccine appointments.
The Minnesota Chapter gave practices small grants to improve transfer of accurate immunization data to the state immunization registry and to implement a QI project for adolescent patients. IIS data were used to assess vaccination rates at the beginning and end of the project. Two practices found that 9% of patients ages 11-12 were up to date with HPV vaccination at baseline. At the end of the QI project, IIS data showed 74% of patients were up to date.
Finally, the AAP Chapter Quality Network recently wrapped up the first phase of its immunization project (see AAP News article “Quality network helps practices improve immunization rates” at http://www.aappublications.org/news/2018/03/28/chapters032818).
