BACKGROUND Adult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates. METHODS This prospective interventional before-and-after non-randomized study was conducted through the American Academy of Family Physicians National Research Network with 43 primary care physicians from a large multi-specialty healthcare organization (multicomponent intervention group n = 23; comparator group n = 20) in the United States. The multicomponent intervention included provider reminders, quarterly provider-level performance reports, provider education, patient visual aid materials, and standing orders on adult pneumococcal, influenza, and zoster immunizations. We assessed individual and comparative provider-level vaccination rates and missed opportunities detailing concordance with targets established by Healthy People 2020 for pneumococcal, influenza, and zoster immunizations. RESULTS Vaccination rates increased after 12 months in intervention and comparator groups respectively for: a). influenza from 44.4 ± 16.7 to 51.3% ± 12.9% (by 6.9 percentage points, p = 0.001) and from 35.1 ± 19.1 to 41.3% ± 14.2%, (by 6.2 percentage points, p = 0.01); b). pneumococcal vaccinations in older adults from 62.8 ± 17.6 to 81.4% ± 16.6% (by 18.6 percentage points, for p < 0.0001) and from 55.9 ± 20.0 to 72.7% ± 18.4% (by 16.7 percentage points, p < 0.0001); and c). zoster from 37.1 ± 13.4 to 41.9% ± 13.1% (by 4.8 percentage points, p < 0.0001) and from 35.0 ± 18.7 to 42.3% ± 20.9% (7.3 percentage points, p = 0.001). Pneumococcal vaccinations in adults at risk did not change from baseline in intervention group (35.7 ± 19.6 to 34.5% ± 19.0%, p = 0.3) and improved slightly in comparator group (24.3 ± 20.1 to 28.2% ± 20.0%, p = 0.003). Missed opportunities reduced after 12 months, most noticeably, for: a). for influenza from 57.7 to 48.6% (by 9.1 percentage points, p < 0.0001) and from 69.7 to 59.6% (by 10.1 percentage points, p < 0.0001); b). pneumococcal vaccinations in older adults from 18.1 to 11.5% (by 6.6 percentage points p < 0.0001) and from 24.6 to 20.4% (by 4.3 percentage points, p < 0.0001) in intervention and comparator groups respectively. CONCLUSIONS Multicomponent interventions show promise in improving vaccination rates and reducing missed opportunities in older adults for pneumococcal and zoster vaccines and vaccination against influenza. Provider reminders remain the most effective strategy when delivered either as a component of these interventions or alone.

中文翻译：

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基于多成分初级保健的干预措施对免疫接种率的影响以及错过为成人接种疫苗的机会。

背景技术成人的免疫率低于《健康人2020年》的目标。我们的目标是评估提高成人免疫率的多组分干预措施的有效性。方法这项前瞻性干预性前后非随机性研究是通过美国家庭医师学会国家研究网络与来自大型多专业医疗组织的43位初级保健医师进行的（多分量干预组n = 23；比较组n = 20）在美国。干预措施包括提供者提醒，提供者季度业绩报告，提供者教育，患者视觉辅助材料以及成人肺炎球菌，流感和带状疱疹免疫的常规命令。我们评估了个人和比较提供者级别的疫苗接种率，错过了详细说明与《健康人2020年》制定的肺炎球菌，流感和带状疱疹疫苗接种目标相一致的机会。结果干预组和比较组在12个月后的疫苗接种率有所提高：流感从44.4±16.7至51.3％±12.9％（下降6.9个百分点，p = 0.001）和从35.1±19.1至41.3％±14.2％（下降6.2个百分点，p = 0.01）; b）。老年人的肺炎球菌疫苗接种率从62.8±17.6至81.4％±16.6％（降低18.6个百分点，p <0.0001）和从55.9±20.0至72.7％±18.4％（降低16.7个百分点，p <0.0001）; 和c）。带状疱疹从37.1±13.4降低到41.9％±13.1％（降低4.8个百分点，p <0.0001），从35.0±18.7降低到42.3％±20.9％（7.3个百分点，p = 0.001）。有风险的成年人的肺炎球菌疫苗接种率与干预组的基线相比没有变化（35.7±19.6至34.5％±19.0％，p = 0.3），而比较组略有改善（24.3±20.1至28.2％±20.0％，p = 0.003） 。12个月后，错失机会减少了，最明显的是：a）。流行性感冒从57.7％下降到48.6％（下降9.1个百分点，p <0.0001），从69.7％下降到59.6％（下降10.1个百分点，p <0.0001）; b）。干预组和比较组的老年人肺炎球菌疫苗接种率分别为18.1％至11.5％（降低6.6个百分点，p <0.0001）和24.6％至20.4％（降低4.3个百分点，p <0.0001）。结论多成分干预措施显示出有望提高老年人的肺炎球菌和带状疱疹疫苗接种率以及预防流感疫苗接种率。提供者提醒作为这些干预措施的一部分或单独提供时，仍然是最有效的策略。