KEYWORD1:
physician education, primary care practice, quality improvement, National Initiative for Children’s Healthcare Quality, Education Physicians In their Communities, AFIX-VFC, teams, immunization rates, public-private partnerships, community programs

BACKGROUND:
75-85% of childhood immunizations are provided by primary care practices. Practices overestimate their immunization rates, do not use recall/reminder systems and do not understand quality improvement. Typical CME does not improve practice performance. The Task Force on Community Preventive Services found that multi-component interventions including education are effective in improving vaccination coverage. Practice-based programs provide education and practical tools. A few also use assessment of rates and quality through CASA and VFC-AFIX. Other state and city initiatives use QI programs to increase rates and quality, others have added community based efforts.

OBJECTIVE:
To understand the value and benefits of different intervention models by comparing educational and quality improvement processes and to provide guidance for choosing interventions depending on clinical community and population.

METHOD:
Review current educational and QI programs that use EPIC, NICHQ and community focused models to determine components used, documented outcomes, and which models work better in different communities.

RESULT:
Many educational programs have added follow-up and QI components in order to assist practices. The QI focused programs are extremely labor and resource intensive for the program and the practices. Multi-component practice and community interventions have worked. There are few documented studies of practice-based educational efforts, and the QI programs have documented positive results.

CONCLUSION:
More research needs to be initiated on the various levels of practice-based intervention to determine the most cost effective intervention to improve both quality and coverage levels.
LEARNINGOBJECTIVES:
Describe the components of educational and quality improvement practice-based and community interventions. Understand the strengths and limitations of the different interventions.