title: Context Matters: Practitioner Perspectives on Immunization Delivery Quality Improvement Efforts.
abstract: Uneven adherence to immunization guidelines might leave some communities vulnerable to outbreaks of vaccine-preventable diseases. To examine factors related to implementation of immunization delivery best practices, we analyzed responses to monthly surveys and debriefing interviews from 16 diverse pediatric practices engaged in a year-long virtual learning collaborative. The collaborative provided a toolkit, online learning sessions, performance feedback, and conference calls with a quality improvement coach. Participants used iterative plan-do-study-act cycles to implement self-selected changes in immunization practices. Descriptive statistics were applied to quantitative data; qualitative data were analyzed using a framework approach. Impediments to implementing guidelines included difficulties with electronic record systems, rigid management structures, competing priorities, and parental resistance. Facilitators included linkage with regional immunization registries, positive social interactions, and performance feedback. Findings suggest that improving immunization delivery requires not only awareness of recommendations and training in improvement methods but also efforts to ameliorate contextual factors that impede immunization delivery.
authors.affiliation: Children's National Health System, Washington, DC, USA jgingold@cnmc.org.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Gingold
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Briccetti
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Zook
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Gillespie
authors.affiliation: Independent Quality Improvement Consultant, Collingswood, NJ, USA.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Gubernick
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Moon
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Linda Y
authors.initials: LY
authors.lastname: Fu
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D010372:Pediatrics / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000706:statistics & numerical data*; D014481:United States
keywords: children; electronic health records; immunization; learning collaborative; practice guidelines; preventive services; primary care; quality improvement; vaccines