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Improving Pediatric Practice Immunization Rates Through Distance-Based Quality Improvement: A Feasibility Trial from PROS

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois, eslora{at}aap.org

Jennifer M. Steffes, MSW

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois

Donna Harris

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois

Herbert W. Clegg, MD

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois, Eastover Pediatrics, Charlotte, North Carolina

David Norton, MD

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois, Holyoke Pediatric Associates, Holyoke, Massachusetts

Paul M. Darden, MD

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois, Medical University of South Carolina, Charleston, South Carolina

Susan A. Sullivan, PhD

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois

Richard C. Wasserman, MD, MPH

Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont

The feasibility and effectiveness of a distance-based quality improvement model were examined in a cohort of Pediatric Research in Office Settings (PROS) practices, with the goal of improving immunization rates and practitioner behaviors and attitudes. Of an initially assessed 82 practices, 29 with baseline rates of 88% for children 8 to 15 months of age were randomized into year-long paper-based education or distance-based quality improvement intervention groups. Outcomes were utility/helpfulness of quality improvement modalities, immunization rate change, and behavior/attitude change. Quality improvement participants attended approximately 75% of monthly conference calls but used the quality improvement Listserv and Web site infrequently (mean 1.09 and 0.92 uses, respectively). Helpfulness ratings of quality improvement modalities mirrored usage. Analyses revealed a 4.9% increase in quality improvement group immunization rates (P = .061), a 0.8% education group increase (P = .752), and a 4.1% difference between groups (P = .261). More quality improvement practices adopted systems identifying children behind in immunizations. A distance-based quality improvement model is feasible and may improve immunization rates.

Key Words: immunizations • quality improvement • primary care • practice-based research networks

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