Adapting Center for Disease Control and Prevention's immunization quality improvement program to improve maternal vaccination uptake in obstetrics

• Type of Material: Article
• Authors: Christine I Spina, University of Colorado Anschutz Medical Campus; Sarah E Brewer, University of Colorado Anschutz Medical Campus; Mallory K Ellingson, Yale School of Public Health; Allison Chamberlain, Emory University; Rupali J Limaye, Johns Hopkins Bloomberg School of Public Health; Walter Orenstein, Emory University; Daniel A Salmon, Johns Hopkins Bloomberg School of Public Health; Saad Omer, Emory University; Sean T O'Leary, University of Colorado Anschutz Medical Campus
• Language: English
• Date: 2020-11-25
• Publisher: ELSEVIER SCI LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.vaccine.2020.10.051
• Title of Journal or Parent Work: VACCINE
• Volume: 38
• Issue: 50
• Start Page: 7963
• End Page: 7969
• Grant/Funding Information: This work was support in part by the National Institutes of Health [grant number R01AI110482]. The funder had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review or approval of the manuscript.
• Keywords: PATIENT; TDAP VACCINATION; Medicine, Research & Experimental; RATES; FEEDBACK; Life Sciences & Biomedicine; ADVISORY-COMMITTEE; Research & Experimental Medicine; PREGNANT-WOMEN; INFLUENZA VACCINATION; Immunology; STATES; COVERAGE; Science & Technology

Abstract

Introduction: Maternal vaccination is critical for improving maternal and child health. Quality Improvement (QI) models1, such as the Centers for Disease Control and Prevention's (CDC) Assessment, Feedback, Incentives, eXchange (AFIX)2 model, have not yet been adapted to maternal vaccinations. This study assesses the impact of AFIX-OB, an adapted version of AFIX for obstetric settings, on maternal vaccination rates. Methods: Between December 2016 and May 2018, state health departments and obstetric practices in Colorado and Georgia implemented the adapted AFIX-OB model. The model addressed unique patterns in patient encounters, practice flow, health records systems and competing clinical priorities in the obstetric setting through a menu of clearly-defined QI strategies, bi-weekly technical assistance meetings with designated immunization champions, incentives for champions/staff, and adapted tools to aid each practice during implementation. Vaccination rates were assessed by random chart reviews pre- and post-intervention. Results: The AFIX-OB model was evaluated in eleven obstetric practices in two states as part of a multi-level intervention to increase maternal vaccination. Post AFIX-OB implementation, documented influenza vaccination rates increased from 56% at baseline to 65% (p < 0.01); and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates increased from 77% at baseline to 84% (p < 0.02) across all practices. Conclusions: The AFIX-OB model showed improvement in maternal vaccination rates for both influenza and Tdap vaccines. AFIX-OB may provide a useful framework for obstetric practices, as well as for other health care specialties. The focused goal should be on broader dissemination among those interested in adopting an evidence-based model for increasing vaccine uptake.