QI at Work: Strategies to Increase Immunization Rates among Children and Adolescents

QI Spotlight Icon Although the value of immunizations is unquestionable among public health and medical practitioners, communities across the country continue to experience challenges achieving the Healthy People 2020 goals for age-appropriate vaccination levels. At the time of this writing, there are 12 Quality Improvement projects on PHQIX on the topic of childhood immunizations. Six of these projects have a specific aim statement related to increasing immunization and/or reducing missed opportunities to vaccinate children and adolescents 1. Health departments can benefit from learning strategies that have been tested as part of these QI efforts and that potentially can be adapted and adopted in other community settings. The following brief synthesis highlights themes across these six projects, provides documentation that may be helpful to health departments seeking to improve vaccination levels among children and adolescents, and includes links to the PHQIX submissions for those who would like additional information.

Root causes of the problem

Root causes of low immunization rates were specific for each particular QI project; however, there were several themes that emerged. Minimal knowledge of current immunization recommendations & reporting requirements was noted by schools and parents. Another theme was that both staff and clients had a limited understanding of immunization services that were available. Several projects noted an inconsistent assessment of immunization status or lack of a standardized immunization tracking system by either health department staff or schools. Finally, skepticism by parents about vaccine side effects and effectiveness, and inconsistent information provided to clients was also noted.

Implementation Strategies

A variety of strategies were implemented by health departments, schools and health care providers to address these root causes and assist in increasing immunization rates among children and adolescents. Training for health department staff was provided. Educational materials and presentations specifically for parents and clients were developed and disseminated. Several health departments implemented surveys to either parents, health care providers or department staff. Health departments also revised immunization related policies and procedures such as standardized tracking sheets and a WIC immunization referral check list. Adding more immunization clinics and advertising them to schools was another strategy implemented by health departments.

The following chart below summarizes the primary root causes and accompanying strategies. Resources generated by these QI efforts are provided below.

Primary Root Causes Revised Policy & Procedures Educational materials for clients Training & educational materials for staff Additional Immunization Clinics
Minimal knowledge of current immunization recommendations & reporting requirements X X X
Limited understanding of services offered by both staff and clients X X X
Inconsistent assessment of immunization status or lack of a standardized immunization tracking system X X
Skepticism by parents about vaccine side effects and effectiveness X X X

Resources developed from PHQIX QI projects to improve immunization rates in children & adolescents

Immunization Policy and Procedures for Health Departments

Immunization related Surveys for Parents, Providers and Staff

Immunization related materials for working with Schools

PHQIX QI Projects to Increase Immunization Rates among Children and Adolescents

Thank you to the following Health Departments who shared their QI projects & resources.

Green Lake County Department of Health and Human Services
Avoiding Missed Opportunities: Immunizing Adolescents in Green Lake County

Kittitas County Public Health Department
Immunization Status of Adolescents in Kittitas County: Immunize at Every Opportunity

Southeast Health District
Improving the Immunization Rate for Children Seen in Public Health Clinics

Spokane Regional Health District
School Immunization Record Review Project

St. Clair County Health Department
WIC Immunization Referral Process

Sullivan County Public Health Services
Improving School Entry Immunization Rates in a Rural New York County

1 The aim statements for the six other Childhood Immunization QI Projects were focused on increasing the efficiency and accuracy of immunization records as well as improving the management of vaccine inventory.

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