Background

High childhood vaccination rates are critical for public health. We hypothesized that implementation of a vaccine education and quality improvement (QI) program, Improving Vaccinations for Young Children (IVY), would improve childhood vaccine rates.

Methods

Eight pediatric practices (3 academic-based, 5 community-based) were randomized to implement IVY within a stepped-wedge cluster randomized trial (SWCRT) in middle Tennessee. Two educational modules on vaccines were developed using best practices in instructional design. Modules were provided electronically and were tailored to providers or office staff. Practices completed in-person QI coaching sessions and selected at least 2 vaccination-related QI changes. Data were collected monthly. The primary analysis examined intervention effect on the primary outcome of Combination 10 vaccination status for children who turned 2 in the previous month. Combination 10 status without influenza vaccine was a secondary outcome, and exploratory analyses assessed intervention effects after adjusting for time and practice type.

Results

Data from 4041 patients (1788 control; 2253 intervention) were collected. The intervention effect was not significant on the primary outcome (OR = 1.01; 95% CI [0.76, 1.34]; P > .9), however there were positive intervention effects in secondary and exploratory models analyzing Combination10 rates without flu, including models adjusting for variation over time (0.20; 95% CI [0.04,0.35]; P = .01) and practice type (higher vaccination rate in academic practices, 0.23; 95% CI [0.03,0.42]; P = .03).

Conclusions

Combination 10 rates were not significantly improved with IVY, yet evidence of beneficial effect on rates without flu vaccine was found. Future studies could evaluate effects over a longer time period and within a larger practice sample.

中文翻译：

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改善幼儿疫苗接种 (IVY)：阶梯楔形集群随机试验

背景

高儿童疫苗接种率对公共卫生至关重要。我们假设实施疫苗教育和质量改进 (QI) 计划，即改善幼儿疫苗接种 (IVY)，将提高儿童疫苗接种率。

方法

在田纳西州中部的一项阶梯楔形集群随机试验 (SWCRT) 中，八项儿科实践（3 项基于学术，5 项基于社区）被随机分配实施 IVY。使用教学设计中的最佳实践开发了两个关于疫苗的教育模块。模块以电子方式提供，专为供应商或办公室工作人员量身定制。实践完成了面对面的 QI 指导课程，并选择了至少 2 个与疫苗接种相关的 QI 变化。数据是每月收集的。主要分析检查了干预对上个月满 2 岁儿童的组合 10 疫苗接种状态的主要结果的影响。未接种流感疫苗的组合 10 状态是次要结果，在调整时间和实践类型后，探索性分析评估了干预效果。

结果

收集了 4041 名患者（1788 名对照；2253 名干预）的数据。干预效果对主要结果不显着（OR = 1.01；95% CI [0.76, 1.34]；P > .9），但是在分析无流感的 Combination10 率的次要和探索性模型中存在积极的干预效果，包括调整模型随时间变化（0.20；95% CI [0.04,0.35]；P  = .01）和实践类型（学术实践中更高的疫苗接种率，0.23；95% CI [0.03,0.42]；P  = .03）。

结论

IVY 的组合 10 率没有显着提高，但发现了对不接种流感疫苗的比率有益的证据。未来的研究可以在更长的时间段和更大的实践样本中评估效果。