Table 1. Intervention strategies used to increase childhood influenza vaccination rates and post intervention effectiveness ratings from Intervention sites.

Strategy		Number of sites using strategy	Effectiveness score* Range = 0-100	Debrief session score** Range = 0-100
	4 Pillars Toolkit
Pillar 1	Convenient vaccination services
Convenient influenza vaccination		10	73.8	46.2
Description: Practices were encouraged to reduce access barriers by offering convenient influenza vaccination services such as after-hours vaccine clinics, walk-in vaccination, dedicated vaccination stations, designated vaccination only hours and vaccination offered at any non-febrile illness visit.
Pillar 2	Notification of parents/patients about the importance of influenza vaccination and the availability of vaccine
Office posters		10	76.7	100
Description: The research team downloaded influenza vaccination posters from the CDC website and provided at least enough to post in each practice's exam rooms. Offices were encouraged to create their own posters and fliers to reminder patient, parents and providers.
Patient reminders		5	20.6	Not rated
Description: Practices were strongly encouraged to notify all parents/patients of the availability of influenza vaccine, date and time of any influenza vaccination clinics, and physician recommendations to be vaccinated. Practices could use any appropriate means, e.g., autodialed phone calls, emails, text messages, “on-hold” messages, fliers, social media, verbal reminders at check-in, etc.
Autodialed phone messages		9	70.0	72.6
Description: The research team worked with the practices to send one or more autodialed message in September, October and December to the entire patient population or a subset (e.g., those still not vaccinated by a certain date) of each practice.
Pillar 3	Enhanced office systems to facilitate influenza immunization
Physician prompts		10	90.7	69.3
Description: The electronic medical record (EMR) was programmed to generate a physician prompt called a best practice alert (BPA) which would appear on the computer screen whenever an unvaccinated child was being seen.
Vaccination as part of vital signs(Immunizations given as part of vital signs)		6	31.5	39.6
Description: Practices were to make influenza vaccination routine by having clinical support staff assess immunization status as part of the process of rooming patients and recording vital signs, and by incorporating SOPs into the practice.
Standing Order Protocols (SOPs)		7	58.6	29.7
Description: Staff would inform the parent, obtain consent, give the Vaccine Information Sheet and prepare the vaccine, and when feasible, vaccinate eligible children without the need for a specific physician's order.
Pillar 4	Motivation through an office immunization champion
Immunization champion (IC)		10	67.7	Not rated
Description: The IC in each practice was an enthusiastic motivator who used her or his time and energy to provide feedback, encourage competition and energize the staff to keep up the efforts throughout the season. The IC shared weekly graphs sent by the research team (see descriptions below under provider and community interventions)depicting the number of vaccines given and missed opportunities to vaccinate and used them as a basis to discuss ways to improve or sustain efforts.
	Provider and community interventions
Pre-intervention visits (Staff/Provider education in-service on toolkit)		10	86.6	100
Description: Investigators visited intervention practice to introduce the study and toolkit at a staff meeting and brainstorm ideas for implementing the 4 pillars in practical and meaningful ways for each practice.
Mid-season refresher (Staff/Provider education online)		9	45.0	Not rated
Description: Staff was offered the opportunity to view a short online slide presentation mid-influenza season, and answer a short survey for which they received participant payment.
Weekly reports (Feedback from investigators)		10	84.2	66.0
Description: Based on the previous year's total number of influenza vaccines given, each practice was given an initial goal of 25% increase over the previous year. This goal was divided into 16 weeks and graphed. Weekly counts of vaccines given were plotted on line graphs comparing actual values with the goal and were emailed to the Immunization Champion (IC) from September through mid-December.
Weekly reports (Comparison of progress with other practices)		10	72.9	66.0
Description: ICs also received a bar graph showing their practices' progress compared with the other intervention sites.
Videos		--	Not rated	59.4
Description: The investigators developed two videos based on focus group findings to encourage teens and younger children to be vaccinated. The teen video was advertised in practices using fliers with a headline to catch teens' attention and a QR code for direct linking to smart phones. A second video was a 30 second public service announcement, produced in collaboration with the county health department and a local television station, and featured a local child celebrity. It played on intervention practices' waiting room electronic message boards and aired 280 times on TV from early September through March 2012.
Community outreach		--	Not rated	Not rated
Description: The research team conducted community outreach, primarily in disadvantaged communities, to reach groups with traditionally low vaccination rates, visiting places of worship, community centers and social service agencies, distributing fliers and talking with people gathered there.
	Vaccine supply/policy interventions
Early delivery of Vaccines for Children (VFC) and donated influenza vaccine		10	94.2	100
Description: Selective early delivery of VFC influenza vaccine to Intervention practices and the delivery of 50-750 doses (distributed proportionally to the size of the practice) of donated influenza vaccine for administration to VFC children. Practices were encouraged to extend the vaccination season by vaccinating as soon as supplies arrived until the end of February.
Borrowing of commercial vaccine for VFC patients		8	40.9	39.6
Description: Investigators received permission for practices to borrow commercial supplies of vaccine to administer to VFC patients until VFC supplies arrived.

Note: NA= not asked.

^*Effectiveness score: Average rating by Intervention arm sites for effectiveness of strategy for raising influenza vaccination rates, effectiveness range= 1-100 with 0=did not use.

^**Debrief session score: Overall assessment of Intervention arm sites' staff on techniques. 0=did not use; 1=not effective; 2=moderately effective; 3=very effective. Average score from all practices then multiplied by 33 to adjust to 0=100 range.