Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA.
J Community Health. 2019 Aug;44(4):790-795. doi: 10.1007/s10900-019-00676-z.
Efforts to understand low human papillomavirus vaccine coverage led us to explore quality improvement (QI) decision-making programs and processes to increase vaccine uptake. These QI programs often include interventions recommended by the AFIX (Assessment Feedback Incentives eXchange) Program that supports Vaccines for Children (VFC) clinics. However, little is known about decision-making around intervention selection or extent of implementation. In collaboration with the state public health department in the rural Midwestern, investigators developed a survey to explore vaccine-related QI in VFC clinics. The survey was distributed via email to all VFC clinics (n = 605); results presented are from the primary care clinics (n = 115). Respondents (VFC liaisons) reported decisions about vaccine QI were made by multiple actors within their own clinics (45.1%), by a clinic manager in charge of multiple clinics (33.0%) and/or at a centralized administrative office (35.2%). Additionally, the majority of respondents considered external actors, like insurance companies (52.7%) or Medicaid/Medicare (50.5%), important to the decision-making process. Most commonly implemented interventions focused on provider knowledge and patient education. Least commonly implemented interventions required systematic changes, such as reminder/recall and follow-up after missed appointments. This preliminary research indicates there are multiple points of decision-making within clinics and health care systems, and therefore change agents at all points need to be involved. The most commonly implemented interventions focus on providers and patients, with an emphasis on education. Interventions requiring system-level changes and use of electronic health records are less common and more attention should be directed towards such interventions.
为了了解人乳头瘤病毒疫苗接种率低的原因，我们探索了质量改进（QI）决策程序和流程，以提高疫苗接种率。这些 QI 计划通常包括支持儿童疫苗计划（VFC）诊所的 AFIX（评估反馈激励交换）计划推荐的干预措施。然而，对于干预措施选择或实施程度的决策，人们知之甚少。在与农村中西部州公共卫生部门合作的过程中，研究人员开发了一项调查，以探讨 VFC 诊所中与疫苗相关的 QI。该调查通过电子邮件分发给所有 VFC 诊所（n=605）；报告的结果来自初级保健诊所（n=115）。受访者（VFC 联络人）报告称，疫苗 QI 的决策是由其诊所内的多个角色（45.1%）、负责多个诊所的诊所经理（33.0%）和/或集中行政办公室（35.2%）做出的。此外，大多数受访者认为保险公司（52.7%）或医疗补助/医疗保险（50.5%）等外部因素对决策过程很重要。最常实施的干预措施侧重于提供者的知识和患者教育。最不常实施的干预措施需要系统的更改，例如错过预约后的提醒/召回和跟进。这项初步研究表明，诊所和医疗保健系统内有多个决策点，因此需要让所有的变革推动者都参与进来。最常实施的干预措施侧重于提供者和患者，重点是教育。需要系统级更改和使用电子健康记录的干预措施较少，应该更加关注这些干预措施。
