Universally Recommended Vaccinations: 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 & 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:

• Client reminder & recall systems
• Clinic-based client education
• Manual outreach & tracking

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

• Interventions to enhance access to vaccinations:
  • Expanded access in health care settings
  • Reduced client out-of-pocket costs
  • Home visits
• Interventions directed at vaccination providers or systems:
  • Provider reminders
  • Standing orders
  • Provider assessment & feedback

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

Task Force Finding & Rationale Statement

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:

• Client or family incentive rewards
• Client reminder & recall systems
• Client-held paper immunization records
• Clinic-based client education
• Manual outreach and tracking

Strategy: Interventions to enhance access to vaccination services:

• Expanded access in healthcare settings
• Home visits
• Reduced client out-of-pocket costs

Strategy: Interventions directed at vaccination providers or systems:

• Provider assessment & feedback
• Provider education
• Provider reminders
• Standing orders

 

Results from the Systematic Review

Sixty-two studies with 74 study arms qualified for the review. 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.

These results were based on a systematic review of available studies, by a team of specialists in systematic review methods, and experts in research, practice and policy related to vaccinations to prevent diseases.

Economic Review

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

Publications

The findings and results of this systematic review have not been published. Read other Community Guide publications about Vaccinations to Prevent Diseases in our library. You may also subscribe to be notified as new materials on this topic become available.

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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. Universally recommended vaccinations: health care system-based interventions implemented in combination. www.thecommunityguide.org/vaccines/universally/healthsysteminterventions.html. Last updated: MM/DD/YYYY.

Review completed: December 2010