title: Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: A Cluster-Randomized Trial.
abstract: To test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars Practice Transformation Program, to increase adult pneumococcal vaccination.
  
  
  
  Randomized controlled cluster trial (RCCT) in Year 1 (June 1, 2013 to May 31, 2014) and pre-post study in Year 2 (June 1, 2014 to January 31, 2015) with data analyzed in 2016. Baseline year was June 1, 2012, to May 31, 2013. Demographic and vaccination data were derived from deidentified electronic medical record extractions.
  
  
  
  Primary care practices (n = 25) stratified according to metropolitan area (Houston, Pittsburgh), location (rural, urban, suburban), and type (family medicine, internal medicine), randomized to receive the intervention in Year 1 (n = 13) or Year 2 (n = 12).
  
  
  
  Individuals aged 65 and older at baseline (N = 18,107; mean age 74.2; 60.7% female, 16.5% non-white, 15.7% Hispanic).
  
  
  
  The 4 Pillars Program, provider education, and one-on-one coaching of practice-based immunization champions. Outcome measures were 23-valent pneumococcal polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine (PCV) vaccination rates and percentage point (PP) changes in vaccination rates.
  
  
  
  In the Year 1 RCCT, PPSV vaccination rates increased significantly in all intervention and control groups, with average increases ranging from 6.5 to 8.7 PP (P < .001). The intervention was not related to greater likelihood of PPSV vaccination. In the Year 2 pre-post study, the likelihood of PPSV and PCV vaccination was significantly higher in the active intervention sites than the maintenance sites in Pittsburgh but not in Houston.
  
  
  
  In a RCCT, PPSV vaccination rates increased in the intervention and control groups in Year 1. In a pre-post study, private primary care practices actively participating in the 4 Pillars Practice Transformation Program improved PPSV and PCV uptake significantly more than practices that were in the maintenance phase of the study.
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.affiliation: Department of Family Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Brown
authors.affiliation: Department of Family Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Valory N
authors.initials: VN
authors.lastname: Pavlik
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Krissy K
authors.initials: KK
authors.lastname: Moehling
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Raviotta
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Chyongchiou J
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Song
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Mary
authors.initials: M
authors.lastname: Hawk
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Shakala
authors.initials: S
authors.lastname: Kyle
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Suchita
authors.initials: S
authors.lastname: Patel
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Faruque
authors.initials: F
authors.lastname: Ahmed
authors.affiliation: Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
mesh_terms: D000368:Aged; D055317:Evidence-Based Practice; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010414:Pennsylvania; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011320:Primary Health Care; D013781:Texas; D014611:Vaccination / Q000706:statistics & numerical data*; D018074:Vaccines, Conjugate / Q000008:administration & dosage
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Tdap vaccine; adults; immunization; pneumococcal conjugate vaccine; pneumococcal polysaccharide vaccine