Can Incentives Work to Increase Adolescent Immunization Rates?

Background: Over the past few years the ACIP and CDC have added multiple vaccines to the routine vaccination schedule for the adolescent age group.  Given the adolescent propensity to avoid routine health care exams as well as injections, it is an area in which providers need to be creative in achieving the Healthy People goal of having 90% of adolescents up to date with appropriate immunizations by the year 2020.  This project included a game entitled “Play to Win” which included a gift incentive to get adolescents to be up to date with recommended vaccines over a 2-year period.  A secondary goal was to customize the EMR used in the practice to be able to recall adolescents who needed immunizations.

Setting: Urban Nursing Center

Population: Adolescents ages 11 to 15

Project Description:  At the onset of this incentive program there were 115 adolescents from ages 11-15 years in the practice who were not up to date for having received 1 Tdap, 1 Meningitis, 2 Hepatitis A, 2 Varicella, 3 HPV (recommended only for females at the onset of this project).  This represented 82% of the adolescents in the practice. Offering a $10 movie pass to a local theater as an incentive for full vaccination succeeded in getting 42.6% of this identified population fully immunized for these recommended vaccinations.

Results/Lessons Learned: Although this falls short of our target of 100% compliance, it represents significant progress in a very difficult inner-city context.  Major changes over the span of this program included the additional recommendation of 3HPV for adolescent males and the implementation of a new EMR into the practice.  The upcoming recommendation for a second dose of meningitis vaccine will once again challenge healthcare providers to find new, creative strategies to engage adolescents so that they become fully immunized.