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Neither financial nor educational programs improve vaccination rates
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Recent study data showed that participating in a financial services program or virtual learning collaborative led to self-reports of increased vaccination rates, although there was little change in actual rates.
“Given the modest effects on immunization rates of both [pay-for-performance (P4P)] and virtual learning quality improvement [QI] collaboratives, the question arises as to whether use of either is worthwhile for improving immunization delivery,” Linda Y. Fu, MD, MS, at the George Washington University School of Medicine, and colleagues wrote.
Since 2000, the American Board of Pediatrics has required participation in QI projects as a requisite for maintenance of certification, the researchers wrote. Little evidence existed, however, on whether these programs impacted patient outcomes. In addition, few studies have shown that P4P can improve patient outcomes.
To determine each program’s value in improving vaccination coverage, Fu and colleagues conducted a single blind, cluster-randomized trial among 32 pediatrics practices between 2013 and 2014, involving 3,147 patients. The P4P intervention (n = 16) used financial incentives (a minimum $500 award per practice) to improve vaccination rates, while the QI incentive (n = 16) employed educational tools. After each intervention, the investigators assessed the percentage of all needed vaccines received (PANVR) as well as immunization up-to-date (UTD) status of patients.
They found nonsignificant increases over time for each intervention group in both PANVR and UTD. While the P4P intervention showed a nonsignificant increase in UTD, the QI intervention showed significant improvement in UTD (adjusted OR = 1.28, 95% CI, 1.02-1.6).
“Our findings suggest that immunization guideline dissemination is a complex process requiring further investigation into factors impacting success,” Fu and colleagues wrote. “Future studies using factorial study designs to compare varying levels of exposure to each intervention or studies that include a third arm that combines aspects of P4P and QI could prove illuminating, but recruitment of enough participants for adequate power might be challenging.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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