Members of the Office Champions team at Barry Pointe Family Care in Kansas City, Mo., are (from left) Dana Granberg, M.D.; Julia Miller, medical assistant; and Patty Evarts, office manager.
With the hurdles posed by the antivaccine movement and general misinformation still impeding family physicians' efforts to fully vaccinate their patient base, the AAFP's Child and Adolescent Immunization Office Champions Project sought to ascertain what a focused effort to improve office immunization rates could lead to.
On Sept. 3, the AAFP published its final report on the project, highlighting outcomes from the 20 participating practices.
Spanning the period from February 2013 to May 2014, the project provided tools and strategies to participating practices to help promote child and adolescent immunization in the office setting, including techniques for
- making strong recommendations for immunizing adolescent patients,
- improving parents' awareness of recommended immunizations,
- reducing missed opportunities to discuss immunization recommendations with patients and
- implementing evidence-based practices to create systems changes.
- On Sept. 3, the AAFP published its Child and Adolescent Immunization Office Champions Project report, highlighting outcomes from the 20 participating practices.
- Techniques the practices used to improve immunization rates included making strong recommendations to immunize adolescents, improving parents' awareness of recommended immunizations and reducing missed opportunities to discuss immunization recommendations.
- The post-project chart review data for adolescent immunizations revealed increases over baseline for all immunization rates measured, from a 12.35 percent uptick for tetanus, diphtheria and acellular pertussis vaccination to a 100 percent rise for HPV vaccination.
Project Outcomes and Highlights
The goal of the project was to develop and implement an Immunization Office Champions program designed to increase child and adolescent immunization rates in family physician practices. The post-project chart review data for child immunizations revealed both slight increases and slight decreases in most practices' immunization rates, with three facilities showing no change. However, the Office Champions project team said in its report that this was not surprising, given that the practices' pre-project chart review numbers were already high.
The post-project results for adolescent immunization rates, on the other hand, revealed dramatic improvements, with an increase over baseline for each immunization evaluated.
Outcomes and highlights included:
- Child immunization rates included a 6.78 percent increase over baseline in vaccination for hepatitis A, and slight increases in vaccinations for varicella (2.27 percent), rotavirus (1.43 percent) and measles, mumps and rubella (1.08 percent).
- Adolescent immunization rate changes over baseline ranged from 12.35 percent for tetanus, diphtheria and acellular pertussis to 100 percent for HPV vaccines (delivering one or more doses).
The project was supported by an educational grant from Merck & Co. Inc.
Feedback From Participants
Kimberly Stuckey-Schrock, M.D., who served as the Physician Champion at project participant Lincoln Avenue Family Medicine in Goshen, Ind., told AAFP News that although the facility's baseline for many infant vaccines was 100 percent, it had room to improve on completing the series of HPV vaccine for both males and females, as well as on providing influenza vaccine to adolescents and hepatitis A vaccine to children.
To improve its HPV series completion rate, Lincoln Avenue Family Medicine handed out appointment reminder cards at the time of the first vaccination and then called patients the day before the second scheduled shot with additional reminders. This led to completion rates for males increasing from 33 percent to 57 percent, said Stuckey-Schrock.
The Office Champions team at Lincoln Avenue Family Medicine in Goshen, Ind., includes (from left) Ivon Arroyo, medical assistant; Minnie Avila, L.P.N.; Ann Cuthbert, N.P.; Michelle Shelly, M.D.; Kim Stuckey-Schrock, M.D.; and Cristina Messick, medical assistant.
For the influenza vaccine, the group found it had lower immunization rates in adolescents than in infants and young children because it didn't see the adolescents as frequently. "So we set up flu clinics and scheduled teens to return for flu shots when we saw them for their school or sports physicals in the summer," said Stuckey-Schrock. "During flu season, our staff was empowered to remind patients it was time for their flu shots and initiated the vaccination process. These rates increased from 40 percent to 82 percent."
For hepatitis A, vaccination rates at the practice improved from 40 percent to 87 percent during the course of the project. She said the staff recognized that frequently they were missing opportunities to deliver this service and increased efforts to do so.
Overall, Stuckey-Schrock said the group benefited from its experience in the Office Champions project.
"Through the resources provided by the AAFP, we educated our staff that sick visits are an excellent time to catch up on missed vaccinations," she said, noting that many of her staff members had automatically assumed a child who was ill or had a fever could not be vaccinated. "Once we got in the mindset of reviewing vaccines at all visits, we were able to catch some children this way."
Dana Granberg, M.D., who served as the Physician Champion at Barry Pointe Family Care in Kansas City, Mo., said her office had a very positive experience working on the project.
Immunization Resources Can Help Boost Vaccine Rates
The AAPF and CDC offer a number of resources that can assist family physicians and their staff in optimizing immunization rates among patients of all ages.
"I think it is like most endeavors in that you will get out of the project what you put into it," she told AAFP News. "We put a lot of effort into the project and, (as a result,) have streamlined our immunization efforts."
Granberg said she was surprised by the initial evaluation results showing that the office's performance before beginning the project was below that of its peers in almost every category. But she said the practice showed significant improvement during the project and concluded the study at or above levels seen among its peers in nearly every category.
One of the biggest successes at Barry Pointe Family Care, according to Granberg, was establishing a protocol that all pediatric patients' immunization charts be kept up-to-date, which called for following up with parents as needed to make sure each scheduled vaccine was completed.
Susan Smith, R.N., director of quality improvement/care coordination services at Fairfax Family Practice Centers in Fairfax, Va., and Office Champion for the organization's 13 facilities, said their results showed significant improvement in adolescent vaccination rates and that participating in the project was beneficial.
"It was a unique experience to be part of a larger group focused on a common issue, get benchmarking ideas and promote better outcomes for our patients," she said. "It allowed us, as an organization, to focus on a quality initiative and make a concerted effort to improve."
Belinda Vail, M.D., a professor and vice chair of clinical affairs at the University of Kansas School of Medicine Department of Family Medicine in Kansas City, served as her group's Physician Champion and said that because they already had good childhood immunization rates, they concentrated on HPV and flu vaccines.
The facility ran a report on all patients ages 13 to 26, identifying those who had not completed their HPV series. Office personnel then called these patients to remind them to come in for the vaccine and offered walk-in times during clinic hours. "We had a large number of patients who came in to receive the HPV vaccine in the subsequent month, but the really interesting part was that they kept coming in for about four to five months after the call," said Vail. "We were able to double our rates of first HPV vaccine and completion of the series."
Vail said the staff enjoyed the project so much, they have now signed up for the AAFP's Tobacco Cessation Office Champions program, as well.
Mitchell Collier, M.D., served as the Physician Champion at Locust Grove Family Physicians in Locust Grove, Okla. He said the practice was pleasantly surprised with its baseline immunization rates but then struggled to significantly improve them. Collier said the office instituted several protocols and was able to slightly raise the numbers.
"While there was not a lot of room for improvement, I think we did make the task easier," he said. "I also think I learned a lot about immunizations. I have always promoted them but participating in this project gave me more tools to use."
Related AAFP News Coverage
Despite Gains, Number of Teens Receiving HPV Vaccine Still 'Unacceptably Low'
CDC Survey Outlines Sketchy Progress Made in Vaccination Effort