Christine I Spina1, Sarah E Brewer2, Mallory K Ellingson3, Allison T Chamberlain4, Rupali J Limaye5, Walter A Orenstein6, Daniel A Salmon7, Saad B Omer8, Sean T O'Leary9. 1. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States. Electronic address: Christine.babbel@cuanschutz.edu. 2. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States. 3. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States. 5. Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. 6. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States. 7. Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. 8. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Yale Institute for Global Health, Yale University, New Haven, CT, United States; Department of Internal Medicine (Infectious Disease), Yale School of Medicine, New Haven, CT, United States; Yale School of Nursing, Yale University, New Haven, CT, United States. 9. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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.
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.
Authors: A T Chamberlain; R J Limaye; S T O'Leary; P M Frew; S E Brewer; C I Spina; M K Ellingson; M Z Dudley; W A Orenstein; M A Donnelly; L E Riley; K A Ault; D A Salmon; S B Omer Journal: Vaccine Date: 2019-04-05 Impact factor: 3.641
Authors: Jennifer L Liang; Tejpratap Tiwari; Pedro Moro; Nancy E Messonnier; Arthur Reingold; Mark Sawyer; Thomas A Clark Journal: MMWR Recomm Rep Date: 2018-04-27
Authors: Sean T O'Leary; Laura E Riley; Megan C Lindley; Mandy A Allison; Lori A Crane; Laura P Hurley; Brenda L Beaty; Michaela Brtnikova; Margaret Collins; Alison P Albert; Allison K Fisher; Angela J Jiles; Allison Kempe Journal: Am J Prev Med Date: 2017-12-13 Impact factor: 5.043
Authors: Sara Mazzoni; Sarah Brewer; Josh Durfee; Jennifer Pyrzanowski; Juliana Barnard; Amanda F Dempsey; Sean T O'Leary Journal: J Reprod Med Date: 2017 Jan-Feb Impact factor: 0.142