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Randomized Controlled Trial
. 2017 Oct 27;35(45):6180-6186.
doi: 10.1016/j.vaccine.2017.09.039. Epub 2017 Sep 22.

Using the 4 Pillars™ Practice Transformation Program to increase adolescent human papillomavirus, meningococcal, tetanus-diphtheria-pertussis and influenza vaccination

Richard K Zimmerman  1 , Jonathan M Raviotta  1 , Mary Patricia Nowalk  2 , Krissy K Moehling  1 , Evelyn Cohen Reis  3 , Sharon G Humiston  4 , Chyongchiou Jeng Lin  1
Affiliations
Randomized Controlled Trial

Using the 4 Pillars™ Practice Transformation Program to increase adolescent human papillomavirus, meningococcal, tetanus-diphtheria-pertussis and influenza vaccination

Richard K Zimmerman et al. Vaccine. .

Abstract

Objectives: To report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population.

Study design: Eleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention. De-identified demographic, office visit and vaccination data were derived from electronic medical record extractions for patients whose date of birth was 4/1/1997 to 4/1/2004 (ages 11-17years at baseline). Vaccination rates for HPV, influenza, tetanus-pertussis-diphtheria (Tdap) and meningococcal (MenACWY) vaccines were determined for all eligible patients pre- and post intervention (i.e., vaccination rates on 4/1/2015 and 4/30/2016).

Results: Among 9473 patients ages 11-17years at baseline (4/1/2015), mean pre-intervention vaccination rates for HPV initiation and completion, meningococcal, Tdap and influenza vaccines were below national levels. Rates increased significantly post intervention (P<0.001) for HPV initiation which increased 17.1 percentage points (PP) from 51.4%; HPV completion increased 14.8PP from 30.7%, meningococcal vaccine uptake increased 16.6PP from 79.1%, Tdap vaccine uptake increased 14.6PP from 76.9%. Influenza vaccine uptake did not increase significantly (2.3PP from 40.1%). In the regression using generalized estimating equations, odds of vaccination were higher for younger, non-white adolescents for all vaccines; being in a smaller practice decreased the odds of Tdap vaccination but increased the odds of influenza vaccination.

Conclusion: Clinically and statistically significant improvements in HPV series initiation and completion, and meningococcal and Tdap vaccinations were observed in primary care practices implementing the 4 Pillars™ Practice Transformation Program. Clinical Trial Registry Number: NCT02165722.

Keywords: 4 Pillars; Adolescent vaccines; HPV vaccination; Tdap vaccination.

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Conflict of interest statement

Conflicts of Interest: Dr. Humiston is a consultant for Hager Sharp Inc. and Pfizer, Inc. Dr. Reis has research funding from Merck & Co., Inc. and Pfizer, Inc. for this project. Drs. Zimmerman and Lin and Ms. Moehling have research funding from Sanofi Pasteur, Inc. Drs. Zimmerman, Nowalk, Lin, Mr. Raviotta and Ms. Moehling have research funding from Pfizer, Inc. and Merck & Co., Inc.

Figures

Figures 1a and b
Figures 1a and b. HPV series initiation (a) and completion (b) for Pennsylvania, United States, pre- and post intervention for adolescents 11–17 years, by sex
Preintervention= rate on 4/1/2015; 2015 Pennsylvania= Pennsylvania 2015 reported rate; 2015 US=United States 2015 reported rate; Post intervention=rate on 4/30/2016
Figures 1a and b
Figures 1a and b. HPV series initiation (a) and completion (b) for Pennsylvania, United States, pre- and post intervention for adolescents 11–17 years, by sex
Preintervention= rate on 4/1/2015; 2015 Pennsylvania= Pennsylvania 2015 reported rate; 2015 US=United States 2015 reported rate; Post intervention=rate on 4/30/2016
Figure 2
Figure 2. Meningococcal, Tdap and influenza vaccination rates for Pennsylvania, United States, pre- and post intervention among adolescents 11–17 years
Preintervention= rate on 4/1/2015; 2015 Pennsylvania= Pennsylvania 2015 reported rate; 2015 US=United States 2015 reported rate; Post intervention=rate on 4/30/2016
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