1857. Using the 4 Pillars™ Immunization Toolkit to Increase Adult Immunizations
Session: Poster Abstract Session: Vaccines: Improving Immunization Uptake
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • 1857_IDWPOSTER.pdf (394.4 kB)
  • Background: Adult vaccination rates continue to fall short of national goals, reinforcing the need to increase vaccination efforts in primary care offices.  The 4 Pillars™ Immunization Toolkit is an interactive evidence-based, step-by-step guide for making patient- provider- and system-oriented changes to improve adult vaccination.  This study tested the effectiveness of the Toolkit to increase adult influenza and Tdap vaccination rates in a randomized controlled cluster trial.

    Methods: 20 practices with adult influenza vaccination rates <70% at baseline (2012-13) were recruited.  Sites, stratified by location (rural, urban and suburban) and type (family or internal medicine), were randomized to the Year 1 (2013-14) intervention (YR1; n=10) or the Year 2 (2014-15) intervention (YR2; n=10) group.  Four YR1 sites continued active intervention in Year 2 (YR1+YR2).  The toolkit and practice improvement options were presented at an all-staff meeting at each practice.  A practice-based Immunization Champion worked with the researchers to implement toolkit strategies and received feedback on vaccines administered.  Goals were set at a 20-25% increase over the number of vaccines given the year before intervention.  Demographic and vaccination data were derived from de-identified EMR extractions for patients ≥18 years. Results at the end of 2 years (2014-15) are presented.

    Results: Over the 2 year study, a cohort of 31,445 adult patients with a baseline mean age = 59.3 years was followed; 42% were men and 5.5% were non-white.

       In YR1 sites, influenza vaccination rate increased from 54% to 59%.  In YR2 sites, influenza vaccination rate increased from 47% to 53%.  In YR1+YR2 sites, influenza vaccination rate increased from 54% to 63% (P<.001 for all comparisons). 

       In YR1 sites, cumulative Tdap vaccination rate increased from 19% to 29%.  In YR2 sites, cumulative Tdap vaccination rate increased from 34% to 48%.  In YR1+YR2 sites, cumulative Tdap vaccination rate increased from 42% to 67%.   Site specific percentage point changes in vaccination rates ranged from 0%-17% for influenza and from 2%-31% for Tdap.

    Conclusion: The 4 Pillars™ Immunization Toolkit appears to be an effective method for increasing adult immunization rates within primary care practices over 2 years.

    Richard K. Zimmerman, MD MPH, FIDSA1, Mary Patricia Nowalk, PhD1, Chyongchiou J Lin, PhD1, Song Zhang, MS2, Krissy Moehling, MPH1, Jonathan Raviotta, MPH1, Mary Hawk, DrPH3, Edmund Ricci, PhD4, Don Middleton, MD5 and Suchita Lorick, DO6, (1)Family Medicine, University of Pittsburgh, Pittsburgh, PA, (2)Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA, (3)Evaluation Institute, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, (4)University of Pittsburgh, Pittsburgh, PA, (5)University of Pittsburgh Medical Center St. Margaret's, Pittsburgh, PA, (6)Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    R. K. Zimmerman, Merck & Co.: Grant Investigator , Research grant
    Pfizer: Grant Investigator , Research grant
    Sanofi Pasteur: Grant Investigator , Research grant

    M. P. Nowalk, Sanofi Pasteur: Grant Investigator , Research grant
    Merck & Co.: Grant Investigator , Research grant
    Pfizer: Grant Investigator , Research grant

    C. J. Lin, None

    S. Zhang, None

    K. Moehling, None

    J. Raviotta, Merck & Co: Consultant , Consulting fee

    M. Hawk, None

    E. Ricci, None

    D. Middleton, Merck &Co, Inc.: Scientific Advisor , Consulting fee and Educational grant
    Sanofi Pasteur: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium
    Pfizer: Scientific Advisor , Consulting fee

    S. Lorick, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.