Key drivers are broad, evidence-based actions that can be useful in the development of more specific ideas for changes that lead to improvement.
Interventions are specific ideas for changing a process; they can be rapidly tested on a small scale to determine whether they result in improvements in a particular context or environment. Each key driver has several associated interventions. The evidence or practice-based tools and resources are paired with the intervention(s) to which they relate. To receive these tools, please contact us.
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Interventions
- Development of a practice-level immunization team with attention to establishing a pro-vaccination culture
“Physician verbiage relative to receiving vaccines is very important, but the whole office attitude is more important.” (IIRA2 Participant)
“Offering incentives to staff will help to increase the number of patients caught up on vaccinations and make it fun for the staff to try creative ways to help the patients.” (IIRA2 Participant) - Establish roles and responsibilities and build into job descriptions and protocols
- Engage providers in the review and agreement to adhere to the current ACIP immunization schedule and catch-up schedule
“Physician verbiage relative to receiving vaccines is very important, but the whole office attitude is more important.” (IIRA2 Participant) - Address provider comfort and hesitancy (e.g., address common myths)
- Promote training of team/staff on QI methodology (including content related to vaccination coverage optimization)
“We thought that everyone did the same thing in regard to MenB but found out that our practices varied greatly between providers. This project allowed us to discuss as a group our clinic policy and implement the same process.” (IIRA2 Participant) - Share data and rapid cycle testing of new approaches/ tools at staff meetings
“ [We] realized [the] importance of including staff in tests of change rather than limiting to provider level only.” (IIRA2 Participant) - Identify and establish internal and external technology interface to promote a sustainable infrastructure for optimized immunization distribution
- Development of a practice-level immunization team with attention to establishing a pro-vaccination culture
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Interventions
- Assess practice-level baseline rates for adolescent immunization coverage
- Create and periodically update process workflow map to establish procedures and identify areas for improvement
“Always make the parent aware of any vaccines that are needed prior to arriving at appointment.” (IIRA2 Participant) - Establish a process to review immunization records at all adolescent appointments prior/at visit including last dose in the series, using EMR or IIS clinic support as prompts as available
“I think one great thing we've learned is having a system to determine if people have fallen behind on well checks. So many families begin to forget to come in for well checks by the time kids are older, so having some system within the clinic to remind them is helpful.” (IIRA2 Participant) - Implement reminder and recall systems to reduce missed opportunities for on-time or catch-up vaccination
- Optimize in-office vaccine management (e.g., purchasing and payment structures)
- Establish scheduling modifications to improve on-time vaccination administration
“Scheduling immunization follow up appointments helped improve vaccination rates and made it easier to track those who fell behind when they no-showed.” (IIRA2 Participant) - Use standing orders for immunization-only visits
- Establish systems to document vaccinerelated conversations and patient immunization status in the medical record and IIS
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Interventions
- Adopt a positive environment toward immunizations in practice policies, documentation, patient portals, practice website, educational materials, etc.
- Maximize community engagement (e.g., social media posts) as a resource to promote pro-immunization practices
- Provide vaccine-promoting videos, and apps tailored to parents/caregivers
- Utilize announcements/ presumptive approaches and advantageous terms Utilize C-A-S-E Technique (Corroborate, About Me, Science, Explain/Advise), “sandwich” technique, and/or motivational interviewing approaches
“[O]ur largest success so far has been presumptive vaccination.” (IIRA2 Participant) - Document delivery of conversation, resources given, recommendations, and vaccine refusal when appropriate
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Interventions
- Provide age-appropriate vaccine-promoting videos, apps, and educational resources tailored to adolescents
- Incorporate confidential time with adolescents at all well visits to foster a trusting relationship and safe space
- Educate and empower adolescents to engage in wellness, inclusive of vaccines (e.g., developing medical care transition processes, advice for how teens can track their own immunization status)
- Develop a plan to address hesitancy including needle comfort strategies for needle-phobic patients
- Implement reminder and recall systems tailored to adolescents
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Interventions
- Employ standards to improve use and reliability of IIS registry and internal technological interfaces
- Establish process to periodically clean up patient panel to accurately reflect true patient population
- Use registry-generated recall reports to track effectiveness and efficiency of recall activities
- Generate periodic population-level data reports, incl. geographic coverage and vaccine usage and recall data reports
Key Driver Diagram
