Comparison of Immunization Quality Improvement Dissemination Study

Study Overview
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Brief Summary
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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.

Conditions
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Chickenpox Vaccine, Immunization, DTaP Vaccine, Hepatitis B Vaccine, MMR Vaccine, HIB-vaccine, Poliovirus Vaccine, Inactivated, Pneumococcal Polysaccharide Vaccine

Intervention / Treatment
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* Behavioral: QI support to improve DTP/Hep B/MMR/Var/PCV/Hib/IPV coverage
* Behavioral: Incentives to improve DTP/HepB/MMR/Var/PCV/Hib/IPV coverage


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: regular patient of a participating practice Exclusion Criteria: fewer than 2 encounters at a participating practice moved or gone elsewhere prior to assessment date medical contraindication to vaccination

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 18 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: quality improvement technical support<br>QI support to improve DTP/Hep B/MMR/Var/PCV/Hib/IPV coverage. Participants receive a Vaccinator Toolkit and attend 6 virtual QI Learning Sessions and 12 monthly conference calls with a coach and other participant teams. On a monthly basis for 11 months, participants collect, submit and review immunization data of 10-20 of their patients ages 3 months to 18 months. After 12 months, participants attend a virtual QI Debriefing Session. | Behavioral: QI support to improve DTP/Hep B/MMR/Var/PCV/Hib/IPV coverage<br>* 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<br>|
| Active Comparator: pay for performance<br>Incentives to improve DTP/HepB/MMR/Var/PCV/Hib/IPV coverage. Participants receive a Vaccinator Toolkit and are informed of a tiered incentives structure. Practices receive bonuses for both improvement in individual practice coverage as well as improvement in coverage for all practices allocated to this study arm. | Behavioral: Incentives to improve DTP/HepB/MMR/Var/PCV/Hib/IPV coverage<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| relative risk of child being up to date with all age-appropriate vaccines as assessed by random selection of 50 patients per practice for compliance with HepB, DTaP, Hib, PCV, IPV, MMR, Var | receipt of all age-appropriate immunization | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| percent of all age-appropriate, indicated vaccines received (HepB, DTaP, Hib, PCV, IPV, MMR, Var) | percent of all needed vaccines received | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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N05.300.150.410, practice guideline, D20.215.894.899.290.130, Health Knowledge, Attitudes, Practice