Adapting Center for Disease Control and Prevention's immunization quality improvement program to improve maternal vaccination uptake in obstetrics

• Published in: Vaccine Vol. 38; no. 50; pp. 7963 - 7969
• Main Authors: Spina, Christine I., Brewer, Sarah E., Ellingson, Mallory K., Chamberlain, Allison T., Limaye, Rupali J., Orenstein, Walter A., Salmon, Daniel A., Omer, Saad B., O'Leary, Sean T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 25-11-2020; Elsevier Limited
• Subjects: Adaptation; Centers for Disease Control and Prevention, U.S; Child; Clinics; Colorado; Data collection; Diphtheria; Diphtheria-Tetanus-acellular Pertussis Vaccines; Disease control; Exchanging; Feedback; Female; Georgia; Health care; Humans; Immunization; Incentives; Influenza; Intervention; Meetings; Obstetrics; Patients; Pediatrics; Pertussis; Pregnancy; Prenatal care; Prevention; Public health; Quality control; Quality Improvement; Success; Tetanus; United States; Vaccination; Vaccines; Whooping Cough; United States; Colorado; Georgia; United States > US
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2020.10.051

•Quality improvement model shows advancement in maternal vaccination rate increases.•Tdap and influenza uptake increase in obstetrics with quality improvement model.•Successful adaption of quality improvement model around maternal vaccination.
Maternal vaccination is critical for improving maternal and child health. Quality Improvement (QI) models11Abbreviation QI: Quality Improvement, such as the Centers for Disease Control and Prevention’s (CDC) Assessment, Feedback, Incentives, eXchange (AFIX)22Abbreviation AFIX: Assessment, Feedback, Incentives, eXchange 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.
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.
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.
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.