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Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination

Health care system-based interventions implemented in combination involve the use of two or more coordinated interventions to increase vaccination rates within a targeted population. Interventions are implemented primarily in health care settings, although efforts may include additional activities within the community.

The selection and implementation of coordinated interventions may result from an overall quality improvement effort in a health care setting.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.

The Task Force further recommends the:

Combination of at least one intervention to increase client demand for vaccinations:

With one or more interventions that address either or both of the following strategies:

The interventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About the Intervention

Combinations of interventions to increase vaccination rates in health systems included 2 or more of the following interventions:

Strategy: Interventions to increase community demand for vaccinations:

Strategy: Interventions to enhance access to vaccination services:

Strategy: Interventions directed at vaccination providers or systems:

Results from the Systematic Review

The Task Force finding is based on evidence from 62 studies with 74 study arms (search period January 1980-November 2009). Most of the studies evaluated combinations of two or three different interventions.

  • Overall change in vaccination rates from the combination of at least two interventions: absolute median increase of 8.0 percentage points (interquartile interval [IQI]: 4 to 21 percentage points; 56 studies, 68 study arms)
    • Increases in vaccination rates were larger when implemented in settings with low rates at baseline.
  • Change in vaccination rates from the combination of at least one intervention each from two different strategies, or from all three strategies: absolute median increase of 16.0 percentage points (IQI: 6 to 26 percentage points; 36 studies, 42 study arms)
  • Health care system-based efforts were effective in increasing vaccination rates when implemented in a range of clinical settings, communities, and client populations.
  • Combined approaches were effective when delivered to both young children (childhood series, and influenza vaccinations) and older adults (influenza and pneumococcal vaccinations).
  • Information on implementation in rural settings was limited and only one of the studies evaluated interventions targeted at adolescents.

Economic Evidence

Two studies qualified for the review, however the information available provides an incomplete assessment of the costs and benefits.

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing appropriate vaccination: health care system-based interventions implemented in combination. Last updated: MM/DD/YYYY.

Review completed: December 2010