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Adolescent girl getting vaccine

Chapters improve adolescent immunization rates despite pandemic challenges

November 1, 2021

In early 2020, the AAP Chapter Quality Network (CQN) engaged five chapters to participate in a quality improvement project to increase adolescent immunization rates. Within weeks of the project kickoff, nearly every U.S state had reported cases of COVID-19, and the project was paused.

The collaborative resumed in the fall of 2020, and 27 practices took on the challenge of improving immunization rates among 16- to 18-year-olds. Participating practices have persevered despite the changing pandemic landscape, staffing shortages and increases in patient volume due to COVID-19 vaccine administration.

Arizona Chapter project leader John A. Pope, M.D., M.P.H., FAAP, said he is proud of participating practices’ ability to commit to the project and work together virtually to share their diverse practice situations and styles as well as ideas on how to improve immunization rates for each cycle of improvement.

“They learned that small changes over time can produce great quality results and the care they provide families. Also, that there can be times when COVID threw a wrench in things, but practices can recover with the next cycle,” he said.

The Arizona Chapter was among five chapters that received grants to participate in the project. The other grant recipients were the North Carolina, Ohio, Pennsylvania and Utah chapters.

Over 95% of participants reported that their practice's adolescent immunization processes improved or significantly improved during the project. Participating practices also saw adolescent immunization rates increase. For example, aggregate HPV series completion rates increased from 56% in September 2020 to 64% in July 2021, and meningococcal B vaccination initiation rates increased from 48% to 62% during the same timeframe.

Practices also achieved significant improvements in their adolescent well visit rate, which increased from 54% to 68% during the project. This accomplishment was particularly notable given the declining rates of well visits nationally during the pandemic.

Finally, missed opportunities to vaccinate adolescents during office visits decreased from 55% to 33%.

Raymond J. Hubbard, M.D., FAAP, Patrick Simonson, FACHE, and Mary Frebel, R.N., who led a team from Reading Pediatrics in Wyomissing, Pa., decided to focus their efforts on reducing missed opportunities after adolescent immunization rates plummeted during the pandemic. First, they tracked adolescent physicals to compile coverage rates. Then, they used internal social media links to alert providers about missed opportunities.

“Improvement followed but then stalled,” Dr. Hubbard said. “Next, our team conducted a small test of change, updating our adolescent template to list all adolescent vaccines including flu, followed by a check box of vaccine given or discussed. This created an awareness for all our providers, and we started to see our missed opportunity rate decrease.”

The practice also solicited quotes from providers on why it’s important for teens to receive the HPV vaccine and used the quotes on a poster that was displayed on all exam room doors.

“The posters were very effective, and parents who viewed them often asked for the HPV vaccine at an earlier age,” Frebel said.

Dr. Pope said commitment from providers and collaboration among chapters helped fuel success.

“It was a big collaboration, and the support from AAP Chapter Quality Network staff and the other chapters in this project really held us all together and helped our providers build capacity and confidence to improve the quality of care we provide in both immunizations and our future work.”

The CQN Improving Immunization Rates for Adolescents learning collaborative was funded by independent grants from Pfizer Inc. and Sanofi Pasteur.


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