title: Comparing in-person and webinar delivery of an immunization quality improvement program: a process evaluation of the adolescent AFIX trial.
abstract: BACKGROUND
  Immunization quality improvement programs are often limited by the cost and inconvenience associated with delivering face-to-face consultations to primary care providers. To investigate a more efficient mode of intervention delivery, we conducted a process evaluation that compared in-person consultations to those delivered via interactive webinar.
  
  
  METHODS
  The Centers for Disease Control and Prevention's Assessment, Feedback, Incentives, and eXchange (AFIX) Program is an immunization quality improvement program implemented in all 50 states. In 2011, we randomly assigned 61 high-volume primary care clinics in North Carolina to receive an in-person or webinar AFIX consultation focused on adolescent immunization. We used surveys of participating vaccine providers and expense tracking logs to evaluate delivery modes on participation, satisfaction, and cost. Clinics served 71,874 patients, ages 11 to 18.
  
  
  RESULTS
  Clinics that received in-person and webinar consultations reported similar levels of participation on key programmatic activities with one exception: more webinar clinics reported improving documentation of previously administered, 'historical' vaccine doses. Both in-person and webinar clinics showed sustained improvement in confidence to use reminder/recall systems (both p < 0.05). Participants rated delivery modes equally highly on satisfaction measures such as convenience (mean = 4.6 of 5.0). Delivery cost per clinic was $152 for in-person consultations versus $100 for webinar consultations.
  
  
  CONCLUSIONS
  In-person and webinar delivery modes were both well received, but webinar AFIX consultations cost substantially less. Interactive webinar delivery shows promise for considerably extending the reach of immunization quality improvement programs.
  
  
  BACKGROUND
  Clinicaltrials.gov, NCT01544764.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.forename: Alyssa J
authors.initials: AJ
authors.lastname: Roberts
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Dayton
authors.forename: Amy H
authors.initials: AH
authors.lastname: Grimshaw
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina, CB 7440, Chapel Hill, NC 27599, USA. ntb@unc.edu.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D002648:Child; D003258:Consumer Behavior; D003365:Costs and Cost Analysis; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000592:standards; D007318:Inservice Training / Q000191:economics / Q000379:methods*; D020407:Internet; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*