Vaccination Programs: Provider Assessment and Feedback

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends provider assessment and feedback programs when used alone or when combined with additional interventions to increase vaccination rates among people of all ages from different populations or settings.

The full CPSTF Finding and Rationale Statement and supporting documents for Vaccination Programs: Provider Assessment and Feedback are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions assess providers’ delivery of one or more vaccinations to a client population and present providers with feedback on their performance. Feedback may cover a group of providers (e.g., average performance for a practice) or an individual provider. Feedback also may involve other components such as incentives or benchmarking.

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (1 study, search period 2007-February 2012).

Study Characteristics

  • Evaluated interventions conducted with children and adults in a wide range of settings and among different target populations

Summary of Results

Twenty studies were included.

  • Overall vaccination rates increased by a median of 9 percentage points (16 studies)
  • Provider assessment and feedback used alone: median increase of 11 percentage points (7 study arms)
  • Used in combination with additional interventions: median increase of 6 percentage points (13 study arms)
  • Relative change in vaccination rates: median increase of 18.0% (15 study arms)
  • Overall vaccination rates among children: median increase of 10.5 percentage points (8 studies with 10 study arms)
  • One study did not provide common measurement and reported no intervention effect

Summary of Economic Evidence

Three studies looked at childhood vaccination series (search period 1980-2012). Monetary values in 2013 U.S. dollars.

  • Cost to implement: $0.22 to $4 per child per year
  • Cost per additional vaccinated child: $80 (1 study)
  • Intervention group size: 1,643 to 18,034 clients
  • Two studies from U.S., one from Canada

Applicability

Findings applicable to children, adolescents, and adults from various populations and in various settings.

Evidence Gaps

  • How effective are these interventions for adolescent populations?
  • What is intervention effectiveness in communities with disparities in vaccination rates?
  • What are effectiveness, utility, and cost-effectiveness of provider assessment and feedback interventions that use regional or state-level immunization information systems (IIS)?

Implementation Considerations and Resources

Implementation barriers include:

  • Lack of adequate information infrastructure
  • Administrative burden on providers and systems
  • An increasingly complex immunization schedule

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