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Rising to the challenge: Contest increases vaccination rates, well visits

April 1, 2022

Enlisting teens to create TikTok videos and administering vaccines at dental visits were among the ways health care organizations responded to a nationwide challenge to increase pediatric vaccination rates and well-child visits.

The Promoting Pediatric Primary Prevention (P4) Challenge was organized by the U.S. Department of Health and Human Services (HHS) through the Health Resources and Services Administration in response to a decline in vaccination rates and well-child visits during the pandemic.

“At the start of the pandemic, the messaging to folks largely revolved around ‘stay home and, unless you are really ill, don’t go into hospitals or clinics,’” said Michael D. Warren, M.D., M.P.H., FAAP, associate administrator of the Maternal and Child Heath Bureau at HHS. “Parents really heeded these warnings. What we started to see in late spring, early summer 2020 was pediatric primary care providers were seeing fewer kids come in. We wanted to think about where there were opportunities to do more.”

The P4 challenge drew applications from more than 240 organizations, and 50 received an initial award of $10,000 and given six months to develop their proposed projects. Twenty winning teams were selected, and each received a final prize of $25,000. Winners include health centers, pediatric clinics, children’s hospitals and community organizations. Challenge projects generated more than 52,000 pediatric well-child visits and nearly 23,000 immunizations.

Among the winners is Fortify Children’s Health in Virginia. Its project, “Increasing Well Visit Rates Among Teens Living in Poverty,” focused on children on Medicaid who faced barriers to care.

“We were concerned about children and adolescents missing out on critical preventive screenings, immunizations and counseling that takes place at annual well visits, especially during the COVID-19 pandemic,” said Suzanne N. Brixey, M.D., FAAP, Fortify Children’s Health executive director. “We wanted to focus on teens because of the unique challenges they faced during the pandemic, including managing their stress and emotions, remote learning, missed significant life events, economic insecurity, etc. We believe adolescents need these preventive visits more than ever.”

Fortify provided support to more than 40 of its primary care clinics to increase outreach to adolescent patients who were behind on well visits. In addition to providing clinicians with patient outreach sheets identifying adolescents who had yet to receive a well visit, Fortify also included patient-level risk stratification data to help practices identify patients who may need extra support.

Dr. Brixey said Fortify saw its target population of 12- to 17-year-olds on Medicaid increase from 12,752 to 13,452 in one year. Fifty-nine percent of those teens lived in neighborhoods classified as “very low opportunity” or “low opportunity” by the Childhood Opportunity Index 2.0.

Fortify also recruited teen patients to create TikTok videos to remind their peers to visit their doctor’s office for a well visit. The videos will be shared on social media later this year.

“We loved seeing their excitement and creativity,” Dr. Brixey said. “(We learned) how critical it is to not just provide population health data, but rather to provide it in a meaningful and actionable manner to our clinical care teams.”

Denver Health won for its project “Partnering Medicine and Dentistry to Increase Vaccination and Well-Child Check Rates in Children Ages 9-17.”

Jessica Jack, M.D., FAAP, said Denver Health saw an opportunity to provide vaccines at dental visits since children ages 9 and older often see their dentists twice each year as opposed to once-a-year visits with their pediatrician. Denver Health integrates dentistry within its medical clinics, and its pilot program utilized three of its six dental clinics to increase immunization rates.

“This seemed like an opportunity to identify patients while they were in the dental home and get them vaccinated while they were seeing their dentist,” Dr. Jack said, adding they targeted HPV, meningococcal and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines.

Dentists discussed various vaccines with patients and asked whether they were up-to-date with their immunizations. At Denver Health’s three clinics, 12% of patients who were due to receive vaccines agreed to be immunized during their dental visit.

“A medical assistant from the medical home would come and give the vaccinations to the patient in the dental chair,” Dr. Jack said. “We did see an overall 5% increase in adolescent vaccinations compared to the year prior, and we were also pleasantly surprised to learn that patients are receptive to talking about vaccines with their dentist and receiving vaccines during dental visits.”

Dr. Warren said he hopes the challenge’s lasting impact will be the relationships many health clinics made with community organizations. The challenge, he said, also showed government can respond in real time to needs across the country.

“There was a real diversity in the applications that were submitted,” Dr. Warren said. “We wanted to emphasize this was really an opportunity to highlight the importance of primary care, medical homes and making sure that kids and their families are connecting back with their pediatric providers.”

To see the list of P4 Challenge winners, visit

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