title: Maintenance of Increased Childhood Influenza Vaccination Rates 1 Year After an Intervention in Primary Care Practices.
abstract: OBJECTIVE
  Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently.
  
  
  METHODS
  Twenty pediatric and family medicine practices were randomly assigned to receive the intervention in either year 1 or year 2. This study focuses on influenza vaccine uptake in the 10 year 1 intervention sites during intervention and the following maintenance year. The intervention included the 4 Pillars Immunization Toolkit-a practice improvement toolkit, early delivery of donated vaccine for disadvantaged children, staff education, and feedback on progress. During the maintenance year, practices were not assisted or contacted, except to complete follow-up surveys. Student's t tests assessed vaccine uptake of children aged 6 months to 18 years, and multilevel regression modeling in repeated measures determined variables related to the likelihood of vaccination.
  
  
  RESULTS
  Influenza vaccine uptake increased 12.4 percentage points (PP; P < .01) during active intervention and uptake was sustained (+0.4 PP; P > .05) during maintenance, for an average change of 12.7 PP over all sites, increasing from 42.2% at baseline to 54.9% (P < .001) during maintenance. In regression modeling that controlled for age, race, and insurance, likelihood of vaccination was greater during intervention than baseline (odds ratio 1.47; 95% confidence interval 1.44-1.50; P < .001) and greater during maintenance than baseline (odds ratio 1.50; 95% confidence interval 1.47-1.54; P < .001).
  
  
  CONCLUSIONS
  In primary care practices, a multistrategy intervention that included the 4 Pillars Immunization Toolkit, early delivery of vaccine, and feedback was associated with significant improvements in childhood influenza vaccination rates that were maintained 1 year after active intervention.
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa. Electronic address: tnowalk@pitt.edu.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Chyongchiou Jeng
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Evelyn Cohen
authors.initials: EC
authors.lastname: Reis
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Huang
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Krissy K
authors.initials: KK
authors.lastname: Moehling
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Hannibal
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Annamore
authors.initials: A
authors.lastname: Matambanadzo
authors.affiliation: Latterman Family Health Center, McKeesport, Pa.
authors.forename: Emeil M
authors.initials: EM
authors.lastname: Shenouda
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Allred
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D055361:Multilevel Analysis; D010372:Pediatrics; D011320:Primary Health Care; D058996:Quality Improvement; D012044:Regression Analysis
chemical_list: D007252:Influenza Vaccines
keywords: children; immunization; influenza; pediatric influenza vaccination; vaccination