Increasing Childhood Influenza Vaccination Rates: Interim Results on the Impact of the Childhood Influenza Vaccination Toolkit

Background: Beginning in 2008, CDC has recommended influenza vaccination for all children ages 6 months to 18 years; however, vaccination rates have been modest.

Objectives: The learner will understand how a multi-faceted approach improves vaccination rates.

Methods: A stratified, randomized cluster trial of 20 diverse pediatric and family  medicine practices, comparing vaccination rates in intervention and control sites in a crossover design was conducted. An evidence-based intervention toolkit called the 4 Pillars was developed: (1) Convenient influenza vaccination services (e.g., express vaccination), (2) patient notification about availability of convenient programs and vaccination recommendation, (3) enhanced office vaccination systems (e.g., systematic assessment by EMR or staff workflow coupled with standing orders and (4) motivation via an office immunization champion tracking progress towards a goal and comparison with other practices (www.immunizationed.org/practiceimprovement). The vaccination season was expanded with a starter supply of vaccine in August.  Interim results provided are from the 10 sites randomized to the intervention arm during the first year, with analysis based upon e-record influenza vaccination reports.  Weekly reports sent to sites included missed opportunities, cumulative total vaccines given, and site ranking comparisons.

Results: Bundling evidence-based strategies in a toolkit resulted in a significant increases in childhood influenza vaccination rates.  Original vaccination goals set for each site targeted a 25% increase over the number of children vaccinated last year. Sites responded so well to the intervention that goals were revised; 8 out of the 10 sites reached an increase >100% of their number vaccinated last year.   Most (93%) staff reported that their practice is doing a better job of influenza vaccination after the toolkit/program.

Conclusions: The 4 Pillar toolkit and the expanded vaccination season resulted in substantially increased childhood influenza vaccination rates.