341. Cluster Randomized Trial to Improve Childhood Influenza Vaccination Rates
Session: Poster Abstract Session: Influenza Vaccine in Children and Adults
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

In the four influenza seasons since the universal childhood influenza vaccination recommendations were made in 2008, influenza vaccination rates have been steadily increasing.  Yet rates remain below the national goal of 80% with many practices vaccinating fewer than half of their patients.  A trial in primary care practices is needed to assess whether a package of interventions can help increase rates and identify factors associated with vaccination status.


Twenty primary care practices treating children were randomly assigned to Intervention and Control arms of a randomized cluster trial to test the effectiveness of the 4 Pillars Toolkit on childhood influenza vaccination rates.  Community level, practice level and research only interventions were implemented.  Hierarchical linear regression modeling was used to evaluate outcomes using personal and practice level variables.


The number of vaccines administered increased in all sites from preintervention to intervention seasons ranging from 3.5% to 169% absolute increases.  Influenza vaccination rates increased significantly in 8/10 Intervention sites (P<0.001) and in 8/10 Control sites (P-values 0.04 to <0.001). The two sites with preintervention vaccination rates greater than 54% in the Intervention arm did not significantly increase their vaccination rates. Absolute differences in rates ranged from 0.6% to 21.5%; mean difference = 8% for Intervention sites and from -3.2% to 9.4%; mean difference = 4.4% for Control sites.  Person level variables which increased the likelihood of a child being vaccinated were younger age group (6-23 months), white race, being commercially insured (P<.001) and practice level variables were preintervention vaccination rate, proportion of the practice patients that was non-white (P<.001) and intervention arm (P=.018).  Early delivery of vaccine was rated by practices as the most effective strategy for raising rates.


For primary care practices whose childhood influenza vaccination rates are below 50%, implementation of a multi strategy toolkit can significantly improve vaccination rates especially effective in practices with large percentages of minority children.

Richard K. Zimmerman, MD MPH1, Mary Patricia Nowalk, PhD1, Chyongchiou J Lin, PhD1, Kristin Hannibal, MD2, Krissy Moehling, MPH1, Hsin-Hui Huang, MD, MPH1, Annamore Matambanadzo, PhD1, Judith Troy, MS1, Greg Gallik, MD, DO3 and Evelyn Reis, MD2, (1)Family Medicine, University of Pittsburgh, Pittsburgh, PA, (2)General Academic Pediatrics, University of Pittsburgh, Pittsburgh, PA, (3)University of Pittsburgh, Pittsburgh, PA


R. K. Zimmerman, Sanofi: Grant Investigator, Grant recipient

M. P. Nowalk, Merck & Co, Inc.: Grant Investigator, Research support
MedImmune LLC: Consultant, Consulting fee

C. J. Lin, MedImmune, LLC: Consultant, Consulting fee
Sanofi Pasteur: Grant Investigator, Research support
Merck and Co.: Grant Investigator, Research support

K. Hannibal, None

K. Moehling, None

H. H. Huang, None

A. Matambanadzo, None

J. Troy, None

G. Gallik, None

E. Reis, None

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