439 - Decreasing missed vaccination opportunities in adolescent primary care through a statewide learning collaborative

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 439
Publication Number: 439.323

Mersine A. Bryan, University of Washington/Seattle Children's Research Institute, Seattle, WA, United States; Nicolas Dundas, Seattle Children's, Seattle, WA, United States; Sarah A. Rafton, Washington Chapter of the American Academy of Pediatrics, Seattle, WA, United States; Elisabeth F. Beaber, Public Health - Seattle & King County, Seattle, WA, United States; jimmy beck, seattle childrens, Seattle, WA, United States; Ariana Salaiz, WCAAP, Pasco, WA, United States; Heather Spielvogle, Seattle Children's, Seattle, WA, United States; Joel Tieder, Seattle Children's and the University of WA, Seattle, WA, United States; Sherri L. Zorn, WA Chapter of American Academy of Pediatrics, Bellevue, WA, United States; Annika M. Hofstetter, University of Washington/Seattle Children's Hospital, Seattle, WA, United States; Douglas J.. Opel, University of Washington School of Medicine, Seattle, WA, United States

Presenting Author(s)

Mersine A. Bryan, MD, MPH (she/her/hers)

Assistant Professor
University of Washington/Seattle Children's Research Institute
Seattle, Washington, United States

Background: Missed opportunities (MOs), healthcare encounters where a child is missing a vaccine and does not receive it, contribute to suboptimal vaccination coverage. Implementing evidence-based best practices has the potential to decrease MOs.

Objective: To decrease MOs for adolescent vaccinations at primary care clinics in Washington State (WA)

Design/Methods: With support from Public Health Seattle & King County, WA State Department of Health, WA Chapter of the American Academy of Pediatrics, and Seattle Children’s Hospital, the WA State Child Health Improvement Partnership enrolled sequential cohorts of primary care clinics in WA from 2019-2022 into a learning collaborative aimed to reduce MOs. The learning collaborative included: a baseline survey to determine vaccination practices and barriers to vaccinating adolescents, quality improvement (QI) education, a menu of evidence-based interventions to improve vaccination rates (e.g. reminder recall, electronic medical record standing orders, daily huddles), 1:1 coaching, and peer benchmarking. Clinics selected ≥1 intervention to implement. Each clinic participated in ≥3 QI coaching sessions to review their MO data and 5 meetings with the full cohort to share learnings. During baseline and intervention periods, each clinic conducted chart review (≥8 adolescent visits over 2-week periods) to identify adolescents due for ≥1 vaccine and, of those, whether they received each required vaccine at each visit. MOs were defined as any in-person visit where an adolescent was due or overdue for a vaccine and did not receive it. We used statistical process control (SPC) p-charts to review MO data at each QI coaching session. Intervention periods were aligned following cohort completion. We used linear regression models to examine pre-post changes in the proportion of MOs by each cohort and for all clinics.

Results:

32 clinics participated in the learning collaborative across 4 cohorts. Cohorts ranged from 4-10 clinics.(Table 1) A mean of 143 charts (standard deviation 38) were reviewed per clinic; 4,568 total visits were included.(Table 2) There was an 11% decrease in MOs using SPC (Figure 1) and a 13% (95% Confidence Interval 9%, 18%) decrease in regression analyses in MOs for adolescents across all 4 cohorts.(Table 2) The change in MOs in the intervention period varied by cohort.(Figure 1)

Conclusion(s): A statewide QI learning collaborative was successful in decreasing the proportion of MOs for adolescent vaccinations. Future directions include collecting race, ethnicity and primary language information to focus further on reducing disparities in vaccination rates.