Comparison of Immunization Quality Improvement Dissemination Study
Condition: Immunization; DTaP Vaccine; Hepatitis B Vaccine; MMR Vaccine; HIB-vaccine; Poliovirus Vaccine, Inactivated; Chickenpox Vaccine; Pneumococcal Polysaccharide Vaccine
MeSH terms: Hepatitis B; Chickenpox
Study type: Interventional

Summary: 
      Dissemination research examines the processes and factors that lead to widespread use of
      evidence-based interventions. There are several theories on how to best minimize the
      perceived and actual burdens on practitioners associated with implementing evidence-based
      medicine. For instance, the pay for performance model attempts to improve physician
      compliance with quality guidelines by providing financial incentives. Recent studies suggest
      pay for performance is effective in improving practitioner performance, but it is unclear
      whether the gains are sustainable once incentives are stopped.

      Another approach to promoting best practices is the Model for Improvement whose main method
      is to employ Plan-Do-Study-Act (PDSA) cycles of small changes Although this approach has been
      successful within individual institutions, there is minimal evidence of its effect when
      employed simultaneously in multiple autonomous institutions. There is also little evidence of
      the sustainability of outcomes after intervention activities end.

      The specific aims of the proposed study are to examine the effect of quality improvement
      dissemination models on the immunization coverage of children ages 3 to 18 months old. The
      investigators propose to:

      1. Determine the effect on immunization compliance of two different models of dissemination
      which will provide physicians 12 months of quality improvement (QI) activity support for
      implementing CDC immunization best practices.

      Hypothesis 1a: Study participants receiving the QI technical support intervention (QITS) will
      have more improvement in immunization rates from baseline to immediately after support ends
      than participants receiving the pay for performance intervention (P4P).

      Hypothesis 1b: Study participants receiving QITS will increase immunization coverage for
      their practices over baseline.

      Hypothesis 1c: Study participants receiving P4P will increase immunization coverage for their
      practices over baseline.
    


Intervention name(s): QI support to improve DTP/Hep B/MMR/Var/PCV/Hib/IPV coverage; Incentives to improve DTP/HepB/MMR/Var/PCV/Hib/IPV coverage
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Quality improvement technical support to help providers' ability to institute best practices to improve delivery of the following vaccines: DTP, HepB, MMR, Var, PCV, Hib, IPV; Financial incentives to support to help providers' ability to institute best practices to improve delivery of the following vaccines: DTP, HepB, MMR, Var, PCV, Hib, IPV
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: N05.300.150.410; practice guideline; D20.215.894.899.290.130; Health Knowledge, Attitudes, Practice