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# What’s the Best way to Increase Immunization Levels?:

June 1, 2016

Adequate immunization levels are important for herd immunity, and practice guidelines shape how immunizations are delivered to individual children.

Adequate immunization levels are important for herd immunity, and practice guidelines shape how immunizations are delivered to individual children. The Healthy People 2020 objective is to achieve a 90% coverage rate among young children for each vaccine recommended by the Centers for Disease Control’s Advisory Committee on Immunization Practices. But what strategies are best are implementing those guidelines?

New research in Pediatrics from Fu et al. (10.1542/peds.2015-4603) looked at a group of pediatric practices with immunization coverage less than 86% and evaluated two practice-based approaches -- web-based learning and pay-for-performance -- geared at increasing that coverage.  The web-based program focused on quality improvement (QI) with six sessions covering immunization schedule, delivery barrier and solutions and parental attitudes.  The pay-for-performance practices could each earn $500 if immunization coverage improved less than 10% and$1,000 if the increase was 10% or higher.

The evaluation, done by a team from National Children's National Health System in Washington, D.C., evaluated results of 32 pediatric practice that participated in the assessment during 2013 and 2014.  Sixteen practices participated in the QI program and 16 in the pay-for-performance.

The practices were assessed by evaluation of 50 medical records of children aged 3-18 months in each practice.  The researchers compared immunization levels at baseline (March 2013) and then after the intervention (June 2014).  They compared the two sets of practices to determine any significant differences between the two groups in the percentage of children who got all needed vaccinations and those who were up-to-date according to the recommended vaccine schedules.

The evaluators found no significant difference in either outcome between the 2 groups.

The study raises questions about whether either approach is effective in improving immunization coverage.  The outcome suggests that immunization delivery is a complex process and neither QI through web-based education nor pay-for-performance is a complete answer to reaching that 2020 goal of 90% immunization coverage.

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