title: Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial.
abstract: New emphasis on and requirements for demonstrating health care quality have increased the need for evidence-based methods to disseminate practice guidelines. With regard to impact on pediatric immunization coverage, we aimed to compare a financial incentive program (pay-for-performance [P4P]) and a virtual quality improvement technical support (QITS) learning collaborative.
  
  
  
  This single-blinded (to outcomes assessor), cluster-randomized trial was conducted among unaffiliated pediatric practices across the United States from June 2013 to June 2014. Practices received either the P4P or QITS intervention. All practices received a Vaccinator Toolkit. P4P practices participated in a tiered financial incentives program for immunization coverage improvement. QITS practices participated in a virtual learning collaborative. Primary outcome was percentage of all needed vaccines received (PANVR). We also assessed immunization up-to-date (UTD) status.
  
  
  
  Data were analyzed from 3,147 patient records from 32 practices. Practices in the study arms reported similar QI activities (∼6 to 7 activities). We found no difference in PANVR between P4P and QITS (mean ± SE, 90.7% ± 1.1% vs 86.1% ± 1.3%, P = 0.46). Likewise, there was no difference in odds of being UTD between study arms (adjusted odds ratio 1.02, 95% confidence interval 0.68 to 1.52, P = .93). In within-group analysis, patients in both arms experienced nonsignificant increases in PANVR. Similarly, the change in adjusted odds of UTD over time was modest and nonsignificant for P4P but reached significance in the QITS arm (adjusted odds ratio 1.28, 95% confidence interval 1.02 to 1.60, P = .03).
  
  
  
  Participation in either a financial incentives program or a virtual learning collaborative led to self-reported improvements in immunization practices but minimal change in objectively measured immunization coverage.
authors.affiliation: Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; lfu@childrensnational.org.
authors.forename: Linda Y
authors.initials: LY
authors.lastname: Fu
authors.affiliation: Goldberg Center for Community Pediatric Health and SciMetrika, LLC, Silver Spring, Maryland;
authors.forename: Kathleen
authors.initials: K
authors.lastname: Zook
authors.affiliation: Goldberg Center for Community Pediatric Health and.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Gingold
authors.affiliation: Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; AARP Public Policy Institute, Washington, District of Columbia;
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Gillespie
authors.affiliation: Goldberg Center for Community Pediatric Health and The George Washington University School of Medicine, Washington, District of Columbia;
authors.forename: Christine
authors.initials: C
authors.lastname: Briccetti
authors.affiliation: Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia;
authors.forename: Denice
authors.initials: D
authors.lastname: Cora-Bramble
authors.affiliation: Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California; and.
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
authors.affiliation: The George Washington University School of Medicine, Washington, District of Columbia;
authors.forename: Rachel
authors.initials: R
authors.lastname: Haimowitz
authors.affiliation: Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; Division of General Pediatrics, University of Virginia School of Medicine, Charlottesville, Virgina.
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Moon
mesh_terms: D006801:Humans; D007858:Learning; D010372:Pediatrics / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D016037:Single-Blind Method; D013663:Teaching; D014481:United States; D014584:User-Computer Interface; D014611:Vaccination / Q000706:statistics & numerical data*