Quality Improvement of Adolescent Vaccination Clinics In Milwaukee Public Schools

Background: The efforts of the Milwaukee Immunization Task Force have resulted in significant increases in vaccination rates at Milwaukee Public Schools (MPS) over the past several years.  To continue to increase vaccination rates and sustain efforts by public health nurses (PHNs) despite declining resources, the Immunization Program at the City of Milwaukee Health Department (MHD) is implementing a quality improvement (QI) project.  The project is funded by the Robert Wood Johnson Foundation

Setting: City of Milwaukee Health Department and Milwaukee Public Schools

Population: School children

Project Description: The immediate goals of the project are to a) improve the efficiency and b) determine the financial self-sustainability of school-based immunization clinics.  Contracted evaluators from the Center for Urban Population Health (CUPH) performed baseline surveys and focus groups to evaluate attitudes and knowledge of staff of MHD about QI methods, as well as attitudes and knowledge of educators and parents about vaccination processes.  Steering Committee members received orientation to QI methods and ongoing training via webinars.  Baseline practices were transcribed to process maps.  MHD staff then met biweekly to conduct rapid Plan-Do-Study-Act cycles on several key processes.  Post-project evaluation will be performed by CUPH staff.

Results/Lessons Learned: Existing processes for local public health practice (e.g., school-based immunization clinic setup and implementation) can be highly variable from nurse to nurse and school to school.  QI methods can identify differences in practices and variations in processes, and provide a structure in which to analyze those differences and move toward standardizing practices.  This, in turn, allows for process improvement and measurement of its effect toward improved outcomes (e.g., improved vaccination rates and improved cost-effectiveness).