Kawczak Steven, Mooney Molly, Mitchner Natasha, Senatore Vanessa, Stoller James K
Education Institute Professional Development, Center for Continuing Education, Cleveland Clinic , Cleveland, OH, USA.
Center for Continuing Education, Cleveland Clinic , Cleveland, OH, USA.
Hum Vaccin Immunother. 2020 Nov 1;16(11):2809-2815. doi: 10.1080/21645515.2020.1737457. Epub 2020 Apr 2.
This study investigated the impact of a longitudinal quality improvement continuing medical education (CME) intervention on influenza and pneumococcal vaccination rates for patient populations at high-risk or aged ≥ 65. An observational cohort design with a propensity score to adjust for vaccine eligibility between the intervention and control cohorts was utilized to assess the impact of the intervention among primary care physicians. The intervention was a three-stage quality improvement initiative with CME learning activities. Stage A was an assessment of practice to establish baseline performance. Stage B was participation in learning interventions and individualized action planning for practice change, and Stage C was practice reassessment. Data were also collected for a control group of clinicians who did not participate during the same period. One hundred primary care physicians completed all 3 intervention stages10/14 - 7/15. Altogether, 361,528 patient records of vaccine receipt were compared for those physicians who completed the educational intervention and those who did not. The percentage of physicians' adult patients receiving influenza or pneumococcal vaccination increased on all measures. The difference between intervention versus control groups was 3.4% higher for influenza ≥ 65 years, 2.1% for influenza high-risk, 0.6% for pneumococcal ≥ 65 years, and 1.4% for pneumococcal high-risk. These results show that physician participation in a quality improvement CME initiative can be an effective strategy to improve vaccination administration. The findings strengthen the evidence that CME learning interventions can advance quality improvement goals and more favorably affect physicians' practice when educational strategies are utilized.
本研究调查了一项纵向质量改进继续医学教育（CME）干预措施对高危或年龄≥65岁患者群体流感和肺炎球菌疫苗接种率的影响。采用观察性队列设计，并使用倾向评分来调整干预组和对照组之间的疫苗接种资格，以评估该干预措施对初级保健医生的影响。该干预措施是一项包含CME学习活动的三阶段质量改进计划。A阶段是对实践进行评估以建立基线表现。B阶段是参与学习干预和针对实践改变的个性化行动计划，C阶段是实践重新评估。同时也收集了同期未参与的临床医生对照组的数据。100名初级保健医生在2014年10月至2015年7月期间完成了所有3个干预阶段。总共比较了完成教育干预的医生和未完成教育干预的医生的361528份疫苗接种患者记录。在所有指标上，医生的成年患者接受流感或肺炎球菌疫苗接种的百分比均有所增加。干预组与对照组相比，65岁及以上人群流感疫苗接种率高3.4%，高危人群流感疫苗接种率高2.1%，65岁及以上人群肺炎球菌疫苗接种率高0.6%，高危人群肺炎球菌疫苗接种率高1.4%。这些结果表明，医生参与质量改进CME计划可以是提高疫苗接种管理的有效策略。这些发现强化了这样的证据，即当采用教育策略时，CME学习干预可以推进质量改进目标，并更有利地影响医生的实践。
