by Cason Benton, MD, FAAP

Preventing illness through vaccinations is foundational to pediatric care. During the pandemic, either because of decreased patient visits or through caregiver concerns about vaccines, vaccination rates protecting young teens from tetanus, pertussis, meningococcus, and cancers decreased. The Alabama Department of Public Health’s ImmPRINT registry indicates that for 11- to 13-year-olds, only 17 percent of patients were up to date on the vaccines for this age group: tetanus-diphtheria-pertussis (Tdap), 60 percent; human papillomavirus (HPV), 17 percent, and meningococcal (MenACWY), 51 percent (data as of July 13, 2021). 

#StayWell 2022: A Teen Vaccine Quality Improvement (QI) Learning Collaborative increases vaccinations statewide 

In 2022, 14 Alabama practices led by Heather Taylor, MD, FAAP from University Medical Center in Tuscaloosa worked collaboratively to increase teen vaccines by five percent over nine months using QI approaches. After assessing current clinic processes, clinic teams selected one or more change ideas to optimize vaccinations based on national recommendations.

Practices completed ACHIA’s self-paced educational modules from national vaccine and vaccine hesitancy experts (Tamera Coyne-Beasley, MD, MPH, FAAP, David Kimberlin, MD, FAAP, and Gregory Zimet, PhD, FSAHM), who also led lively discussions on these topics during monthly webinars.

QI coaches helped practices use tools such as Key Drivers, SMART Aims, Plan-Do-Study-Act cycles, Pareto Charts, and run charts during the monthly webinars. The most beneficial aspects of the collaborative noted by participants were the shared common barriers and ideas to overcome those barriers during peer-to-peer discussions.

Teen vaccines meet or exceed aims

The collaborative aim to increase Tdap, HPV, and MenACWY vaccinations by five percent was met and exceeded for all three. Participants said that the most impactful changes were:

  • Offering vaccines at younger ages and visits other than health supervision visits;

  • Establishing pre-clinic nursing chart reviews and huddles to assess vaccine needs;

  • Standing orders and using evidence-based communication strategies.

In addition to meeting the goal of improving vaccination rates, clinic teams also valued obtaining CME and ABP Maintenance of Certification Part II and IV credit as well as the enhanced team-building.

Sustaining Improvements

Participating practices serve as the medical home for 10 percent of Alabama’s 9- to 13-year-olds. With sustained improved vaccination rates, there will be substantial decreases in preventable illnesses and cancers in the decades to come. To support the continuation of best practices, ACHIA will provide annual vaccination rate data to practices for the next several years.

Improving your clinic's vaccination rates 

Those who did not participate in the collaborative can still apply the lessons learned in their practices by:

  • Accessing ACHIA resources. Begin with the Key Driver to craft your measurable aims and review hundreds of change ideas. 

  • Participating in the ACHIA Teen Vaccine Mini-Workshop led by Dr. Taylor at the Chapter's Spring meeting in May, which will emphasize peer-to-peer learning.

Best Vaccination Practices

  • Maintain immunization registries 

  • Standardize standing orders and reminder/recall workflows 

  • Create a culture supportive of vaccinations 

  • Expand opportunities to vaccinate 

  • Understand vaccine hesitancy and utilize evidence-based communication

This article first appeared in the First Quarter 2023 Edition of the Alabama Pediatrician Newsletter.