Table 1.
Study Characteristics of Healthcare-based Quality Improvement Interventions to Increase Seasonal Influenza Vaccination (n=29)
| Author | Description of intervention (Matches recommendations by health authorities) | Setting | Population | Clinical study design, comparator | Vaccination rate in comparison group | Difference in vaccination rates (unadjusted) |
|---|---|---|---|---|---|---|
| Interventions focused on general populations | ||||||
| Efforts by provider entities to promote vaccination among the patients they treat | ||||||
| Hull 2002 | Receptionists at practices called intervention households and offered appointments at a nurse-run immunization clinic (N/A) | 3 general practice clinics in England | 1,318 low-risk adults aged >65 years | RCT, status quo | 44% | +6.0% |
| Honeycutt 2007A | Standing orders: Non-physician personnel screened for contraindications and then delivered vaccines without patient-specific orders (N/A) | 3 rural and 1 urban hospital in U.S. | Adult inpatients at high risk | Compare d site and published data, status quo | 1.8% (literature) | +7.1% (range 3.2%–11.7%) |
| Honeycutt 2007B | Pre-printed orders: Staff placed unsigned orders for vaccination in locations where physicians could sign them (CPSTF) | 2 rural and 1 urban hospital in U.S. | Adult inpatients at high risk | Compare d site and published data, status quo | 1.8% (literature) | +1.4% (range 1.0%–1.9%) |
| Honeycutt 2007C | Physician reminders: Staff placed notes in patient records to prompt physicians to assess eligibility and order vaccination (CPSTF) | 3 rural hospitals in U.S. | Adult inpatients at high risk | Compared site and published data, status quo | 1.8% (literature) | +6.1% (range 1.0%–16.0%) |
| Lam 2008 | Pharmacist-conducted vaccine service: Pharmacists and nurses reviewed charts to screen for contraindications and administered vaccines (NVAC) | Assisted living facility in Seattle | 70 indigent, older Asian adults | UCBA, status quo | 64.2% | +18.7% |
| Teufel 2008 | Hospital vaccinations: Registered nurse screened patients for eligibility, communicated with families, and administered vaccine (NVAC) | Hypothetical acute care hospitals in the U.S. | Hospitalized children with asthma | Model based on published data, status quo | 29% (literature) | +30% (with 100% screening) |
| Prosser 2008 | Pharmacy vaccinations: Pharmacists delivered vaccines in an outpatient pharmacy (NVAC) | 5 pharmacies in U.S. | U.S. adults | Model based on site and published data, no vaccination | Not reported | NR |
| Patterson 2012A | Emergency department staff vaccinated older adults presenting for emergent care (NVAC) | Hypothetical emergency departments in the U.S. | U.S. adults aged >50 years | Model based on published data, status quo | 66% (literature) | 80.7% receive vaccine in emergency department |
| Patterson 2012B | Emergency department staff vaccinated older adults presenting for emergent care (NVAC) | Hypothetical emergency departments in the U.S. | U.S. adults aged >65 years | Model based on published data, status quo | 35% (literature) | 80.7% receive vaccine in emergency department |
| Herrett 2016 | General practices sent tailored text message to patients reminding them to get vaccinated; included practice name and phone number (N/A) | 156 general practices in the United Kingdom | Patients aged 18–64 years with chronic conditions | Cluster RCT, status quo | 50.7% | +2.62% |
| Michaelidis 2013A | Outpatient clinics sent autodialed telephone reminders (N/A) | Hypothetical outpatient clinics in the U.S. | African-American and Hispanic birth cohort aged 65 years in 2009 | Model based on published data, status quo | 61% | +8% by year 3 |
| Michaelidis 2013B | Outpatient clinics sent autodialed telephone reminders and established standing orders (N/A) | Hypothetical outpatient clinics in the U.S. | African-American and Hispanic birth cohort aged 65 years in 2009 | Model based on published data, status quo | 61% | +16% by year 3 |
| Michaelidis 2013C | Outpatient clinics sent autodialed telephone reminders, established standing orders, and preformed audit and feedback strategies (N/A) | Hypothetical outpatient clinics in the U.S. | African-American and Hispanic birth cohort aged 65 years in 2009 | Model based on published data, status quo | 61% | +20% by year 3 |
| Michaelidis 2013D | Outpatient clinics sent autodialed telephone reminders, established standing orders, performed audit and feedback and assigned vaccination champion (N/A) | Hypothetical outpatient clinics in the U.S. | African-American and Hispanic birth cohort aged 65 years in 2009 | Model based on published data, status quo | 61% | +20% by year 3 |
| Shoup 2015A | Interactive voice response: automated telephone service reminded patients to obtain vaccine for free and without appointment, and offered more information if desired (N/A) | Integrated healthcare organization in the U.S. | 12,428 adults aged 19–64 years with asthma or COPD | 3-arm RCT, status quo plus postcard reminder | 29.5% (postcard reminder only) | +1.6% |
| Shoup 2015B | Interactive voice response and postcard: automated telephone service reminded patients to obtain vaccine for free and without appointment, and offered more information if desired. Postcard reminders were also sent (N/A) | Integrated healthcare organization in the U.S. | 12,428 adults aged 19–64 years with asthma or COPD | 3-arm RCT, status quo plus postcard reminder | 29.5% (postcard reminder only) | +1.1% |
| Stuck 2015 | Health risk assessment, computer generated feedback to patients and primary care providers, and counseling to promote multiple primary prevention and screening behaviors (N/A) | 19 primary care clinics in Switzerland | 2,284 community-dwelling adults aged >65 years | RCT, status quo | 59.2% | +6.6% |
| Atkins 2015 | City-wide vaccination program administered by pharmacists (NVAC) | 1,230 pharmacies in London | Adults | UCBA, status quo | 60.4% (year prior) | +0.01% |
| Efforts by public or private payers to promote vaccination among beneficiaries | ||||||
| Berg 2008 | Two waves of mailings sent by payer that described the benefits of vaccination particularly for high risk groups, the timing of vaccination, and the benefits of hand-washing (CPSTF) | Preferred provider organization in 5 U.S. states | 107,927 households of federal employee s aged >65 years | RCT, status quo | 20.76% | −0.02% |
| Terrell-Perica 2001A | Influenza mailer: State send mailings encouraging beneficiaries to take advantage of Medicare coverage for influenza vaccination (CPSTF) | Department of Health, Hawaii | 6,528 newly eligible Medicare beneficiaries aged >65 years | 3-arm RCT with 2 intervention groups, status quo | 17.1% | +2.7% |
| Terrell-Perica 2001B | Influenza/pneumococcal mailer: State send mailings encouraging beneficiaries to take advantage of Medicare coverage for both influenza and pneumococcal vaccination (CPSTF) | Department of Health, Hawaii | 6,528 newly eligible Medicare beneficiaries aged >65 years | 3-arm RCT with 2 intervention groups, status quo | 17.1% | +3.8% |
| Ohkusa 2005 | A national immunization program reduced patient copayments by subsidizing a portion of the cost of vaccination; copayments vary across cities (CPSTF) | 13 large cities in Japan | Elderly adults | Cross-sectional analysis of variation in vaccination rate with size of copayment, status quo | 29.7% | +7.0% per $8 increase in subsidy |
| Hoshi 2007 | A national immunization program reduced patient copayment by subsidizing 71% of the cost of vaccination (hypothetical intervention) (CPSTF) | Japan | Adults aged >65 years | Model based on country-specific data, status quo (zero subsidy) | Normal risk individual 7.6%, High risk individual 9.5% | +38.7% among both normal and high risk individuals |
| Interventions focused on healthcare workers | ||||||
| Leitmeyer 2006 | Nationwide campaign that engaged stakeholders and sent promotional and training materials to hospitals (CPSTF, NVAC) | 2,000 hospitals in Germany | German healthcare workers | UCBA, status quo | 21% (based on 20 hospitals) | +5% (based 20 hospitals) |
| Lin 2012A | Education and publicity: promotional materials, free mass vaccination clinics, feedback to hospital leaders (no incentives or carts) (CPSTF, NVAC, JC) | 2 of 11 hospitals in a health system in Pennsylvania | 2,016 personnel other than physicians and trainees | UCBA, status quo | 34.3% (derived) | +3% (37.3% vaccinated in follow-up group) |
| Lin 2012B | Mobile vaccine carts: In addition to education and publicity, an emergency medical technician visited all clinical units during all shifts over 2 months (CPSTF, NVAC, JC) | 2 of 11 hospitals in a health system in Pennsylvania | 3,961 personnel other than physicians and trainees | UCBA, status quo | 31.5% (derived) | +7% (38.5% vaccinated in follow-up group) |
| Lin 2012C | Incentives: In addition to education and publicity, vaccinated personnel received incentives ($10 gift card, lottery for paid time off, or party) (CPSTF, NVAC, JC) | 4 of 11 hospitals in a health system in Pennsylvania | 7,029 personnel other than physician s and trainees | UCBA, status quo | 32.2% (derived) | +9% (41.2% vaccinate d in follow-up group) |
| Lin 2012D | Incentives and mobile vaccine carts: In addition to education and publicity, both incentives and vaccine carts were used (CPSTF, NVAC, JC) | 3 of 11 hospitals in a health system in Pennsylvania | 14,227 personnel other than physicians and trainees | UCBA, status quo | 33.4% (derived) | +6% (39.4% vaccinate d in follow-up group) |
| LaVela 2015 | Influenza declination form program for healthcare workers (NVAC) | 2 spinal cord injury centers in Veterans Affairs hospitals | 173 healthcare workers | UCBA, status quo | 53.5% | +23.9% (worker self-report) |
Note: Boldface indicates statistical significance (p<0.05).
NR, not reported; N/A, not applicable; UCBA, uncontrolled before-after analysis; CPSTF, Community Preventative Services Task Force; NVAC, National Vaccine Advisory Committee, U.S. DHHS; JC, The Joint Commission; COPD, chronic obstructive pulmonary disease