Child/Adolescent Health

Conference calls, E-mail discussion groups, and targeted Web sites may improve pediatric practice immunization rates

Pediatricians who participate in monthly conference calls, LISTSERV™ E-mail discussion groups, and have access to a Web site that that shares best practices and information focused on improving immunization rates may improve their immunization rates over those who only receive mailed educational materials, finds a new study. This distance-based approach to quality improvement (QI) is more cost-effective than face-to-face education and can reach many pediatric practices, notes Eric J. Slora, Ph.D., of the Pediatric Research in Office Settings (PROS), a practice-based research network (PBRN) supported by the American Academy of Pediatrics.

Dr. Slora and colleagues randomly assigned 29 PROS practices into year-long, paper-based education or distance-based QI groups to examine differences in immunization rates at the end of the year. The practices had similar baseline immunization rates of 88 percent or less for children 8 to 15 months.

Pediatricians in the QI group, most of whom were in their 50s, made most use of the conference calls, attending about 75 percent of them. However, the QI LISTSERV™ and Web site were used infrequently, averaging once per practice over the entire year. Pediatricians' assessments of the helpfulness of each resource mirrored practice use. For example, they rated conference calls (1=very helpful, 2=somewhat helpful, and 3=not helpful at all) an average of 1.38 compared with 1.86 for the Web site and 2.0 for the LISTSERV™. Practices in the QI group boosted their immunization rates by 4.9 percent (from 75.9 to 80.8 percent) compared with 0.8 percent (from 81.6 to 82.4 percent) in the paper-based education group. Also, more QI practices adopted systems identifying children behind in immunizations in their practices.

The researchers conclude that a distance-based QI model is feasible and may improve immunization rates. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13512).

More details are in "Improving pediatric practice immunization rates through distance-based quality improvement: A feasibility trial from PROS," by Dr. Slora, Jennifer M. Steffes, M.S.W., Donna Harris, M.A., and others in the January 2008 Clinical Pediatrics 47(1), pp. 25-36.

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