Universally Recommended Vaccinations: Provider Assessment & Feedback

Task Force Finding & Rationale Statement

Definition

Provider assessment and feedback involves retrospectively evaluating the performance of providers in delivering one or more vaccinations to a client population and giving this information as feedback to the providers. Assessment and feedback can also involve other activities (e.g., incentives or benchmarking).

Task Force Finding

Assessment and feedback for vaccination providers is recommended based on strong evidence of effectiveness in improving vaccination coverage: (1) in adults and children; (2) whether used alone or with additional components; and (3) across a range of settings and populations. The review team could not determine which of the characteristics of assessment and feedback contributed most to its effectiveness; however, a variety of assessment and feedback strategies have been consistently effective in a wide range of contexts.

Rationale

In 1997 the Task Force found strong evidence of effectiveness for provider assessment and feedback. Based on the findings of this 2007 update, the Task Force reaffirms their original recommendation.

Our previous review (search period 1980–1997) included 14 studies with a median absolute increase in vaccination coverage of 16 percentage points. Five studies evaluated assessment and feedback for providers when implemented alone (median absolute increase of 17 percentage points), and nine studies examined this intervention with additional components (median absolute increase of 16 percentage points).

The updated review (search period 1997–2007) identified 19 additional studies. Of these, 16 studies with 20 study arms provided common measurements of change in vaccination coverage. The median absolute change was an increase of 9 percentage points (interquartile interval [IQI]: 3 to 14 percentage points). Fifteen study arms provided sufficient information to calculate the relative change in vaccination coverage with a median increase of 18.0% (IQI: +9.5% to +24.0%). Seven study arms evaluated the impact of assessment and feedback for providers when implemented alone with a median absolute increase of 11 percentage points (IQI: 7 to 12 percentage points). Thirteen study arms evaluated provider assessment and feedback with additional components, and observed a median absolute increase of 6 percentage points (IQI: 3 to 18 percentage points).

The reviewed studies evaluated the impact of assessment and feedback for vaccination providers in a wide range of target populations, settings, and for most vaccines with universal indications for adults and for children. Although no studies specifically evaluated the impact of assessment and feedback for vaccination of adolescents, the Task Force considers the available evidence as applicable to efforts to improve vaccination coverage in this population.

No evidence of harms regarding the use of assessment and feedback for providers was identified in either the original review or in this update.

The Task Force notes that the studies included in this 2007 review had changes in vaccination coverage that are smaller in magnitude than those reported from studies included in the 1997 review. However, the effect estimates from this review remain of sufficient magnitude to support a conclusion of effectiveness and a recommendation for the use of assessment and feedback for providers to improve vaccination coverage.