Using the 4 Pillars (TM) Practice Transformation Program to increase adult Tdap immunization in a randomized controlled cluster trial

作者：Nowalk Mary Patricia^*; Lin Chyongchiou J; Pavlik Valory N; Brown Anthony E; Zhang Song; Moehling Krissy K; Raviotta Jonathan M; South Paul Jeannette E; Hawk Mary; Ricci Edmund M; Middleton Donald B; Patel Suchita A; Ahmed Faruque; Zimmerman Richard K

来源：Vaccine, 2016, 34(41): 5026-5033.

DOI：10.1016/j.vaccine.2016.07.053

• Tdap vaccine
• Immunization
• Adults
• Pertussis
• Tetanus

Introduction: National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars (TM) Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the 4 Pillars (TM) Program, provider education, and one-on-one coaching of practice-based immunization champions.
Methods: 25 primary care practices participated in a randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013-5/31/2014) and a pre-post study in Year 2 (6/1/2014-1/31/2015). Baseline year was 6/1/2012-5/31/2013, with data analyzed in 2016. Demographic and vaccination data were derived from de-identified electronic medical record (EMR) extractions. The primary outcomes were vaccination rates and percentage point (PP) changes/year.
Results: The cohort consisted of 70,549 patients >= 18 years who were seen in the practices >= 1 time each year, with a baseline mean age = 55 years; 35% were men; 56% were non-white; 35% were Hispanic and 20% were on Medicare. Baseline vaccination rate averaged 35%. In the Year 1 RCCT, cumulative Tdap vaccination increased significantly in both intervention and control groups; in both cities, the percentage point increases in the intervention groups (7.7 PP in Pittsburgh and 9.9 PP in Houston) were significantly higher (P < 0.001) than in the control groups (6.4 PP in Pittsburgh and 7.6 PP in Houston). In the Year 2 pre-post study, in both cities, active intervention groups increased rates significantly more (6.2 PP for both) than maintenance groups (2.2 PP in Pittsburgh and 4.1 PP in Houston; P < 0.001).
Conclusions: An intervention that includes the 4 Pillars (TM) Practice Transformation Program, staff education and coaching is effective for increasing adult Tdap immunization rates within primary care practices.

• 出版日期2016-9-22