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Randomized Controlled Trial
. 2016 Sep 22;34(41):5026-5033.
doi: 10.1016/j.vaccine.2016.07.053. Epub 2016 Aug 26.

Using the 4 Pillars™ Practice Transformation Program to increase adult Tdap immunization in a randomized controlled cluster trial

Mary Patricia Nowalk  1 , Chyongchiou J Lin  2 , Valory N Pavlik  3 , Anthony E Brown  3 , Song Zhang  2 , Krissy K Moehling  2 , Jonathan M Raviotta  2 , Jeannette E South-Paul  2 , Mary Hawk  4 , Edmund M Ricci  4 , Donald B Middleton  2 , Suchita A Patel  5 , Faruque Ahmed  5 , Richard K Zimmerman  6
Affiliations
Randomized Controlled Trial

Using the 4 Pillars™ Practice Transformation Program to increase adult Tdap immunization in a randomized controlled cluster trial

Mary Patricia Nowalk et al. Vaccine. .

Abstract

Introduction: National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars™ Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the 4 Pillars™ Program, provider education, and one-on-one coaching of practice-based immunization champions.

Methods: 25 primary care practices participated in a randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013-5/31/2014) and a pre-post study in Year 2 (6/1/2014-1/31/2015). Baseline year was 6/1/2012-5/31/2013, with data analyzed in 2016. Demographic and vaccination data were derived from de-identified electronic medical record (EMR) extractions. The primary outcomes were vaccination rates and percentage point (PP) changes/year.

Results: The cohort consisted of 70,549 patients ⩾18years who were seen in the practices ⩾1 time each year, with a baseline mean age=55years; 35% were men; 56% were non-white; 35% were Hispanic and 20% were on Medicare. Baseline vaccination rate averaged 35%. In the Year 1 RCCT, cumulative Tdap vaccination increased significantly in both intervention and control groups; in both cities, the percentage point increases in the intervention groups (7.7 PP in Pittsburgh and 9.9 PP in Houston) were significantly higher (P<0.001) than in the control groups (6.4 PP in Pittsburgh and 7.6 PP in Houston). In the Year 2 pre-post study, in both cities, active intervention groups increased rates significantly more (6.2 PP for both) than maintenance groups (2.2 PP in Pittsburgh and 4.1 PP in Houston; P<0.001).

Conclusions: An intervention that includes the 4 Pillars™ Practice Transformation Program, staff education and coaching is effective for increasing adult Tdap immunization rates within primary care practices. Clinical Trial Registry Name/Number: NCT01868334.

Keywords: Adults; Immunization; Pertussis; Tdap vaccine; Tetanus.

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Conflict of interest statement

Drs. Zimmerman and Lin have a research grant from Sanofi Pasteur, Inc. Drs. Zimmerman, Nowalk and Lin have research grants from Merck & Co, Inc., and Pfizer, Inc. Dr. Middleton is a lecturer for Sanofi Pasteur and Merck & Co. and a physician advisor for Sanofi Pasteur, Pfizer, Inc. and Merck & Co. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Randomization Scheme - CONSORT
Figure 2
Figure 2
Intervention Strategies Used to Increase Adult Vaccination Rates from the 4 Pillars™ Practice Transformation Program
See this image and copyright information in PMC

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