Table 3.

Classification of quality improvement interventions (change ideas) used in quality improvement projects to address missed opportunities for vaccination.

Interventions for providers	Interventions for clients	Cross-cutting interventions
Place registry-generated copy of child’s immunization data on front of chart at every visit41	Providing a strong recommendation for vaccination at every visit42	Improve record keeping by keeping immunization history current49
Make notation on clinician encounter form whenever child is due to visit41	Using patient reminder systems42	Record keeping51
Educate providers regarding methods for reducing missed opportunities41	Implementing campus-based marketing strategies42	Developing an immunization registry to track patients50
Place reminder posters prominently in clinic41	Use of consistent language to recommend HPV vaccine43
Prevent missed opportunities to vaccinate by increasing provider acknowledgement of vaccine history42	Provider emphasizing the vaccine as a tool for cancer prevention43
Distributing immunization records for all scheduled pediatric patients to provider medical-assistants teamlets44	Provider emphasizing the vaccines at acute visits43
Educational seminar on HPV for physicians, residents, nurses, and medical assistants45	Mailing letters to caregivers of children under 3 years of age providing information on reasons for immunization and encourage them to make appointment to obtain missing immunizations44
Weekly individualized audit to providers who missed an opportunity to vaccinate a patient against HPV45	Administering all recommended vaccines at the same visit46
Allowing staffs to schedule their HPV visits45	Making strong recommendations for vaccines46
Support staffs indicating to providers when client is HPV vaccine eligible45	Discussing the need for immunizations with caregivers at that day’s visit48
“Best practice alert” for HPV in EMR45	Use all clinical encounter to screening at every visit49
Electronic reminders using Huddle45	Administer immunization at some sick visits49
Auditing and feedback46	Administer immunization at any opportunity49
Providers were trained on offering a strong recommendation for HPV vaccination47	Using only true contraindication to immunization49
Practices implemented provider prompts and/or standing orders and/or reminder/recall if desired47	Simultaneous administration of multiple vaccines49
Provide monthly feedback on missed opportunities for vaccination to assess their progress47	Administering DTP at 12 or 15 months instead of 18 months49
Teach residents about the principles of FOCUS-PDSA through didactic lecture48	Recommendations pertained to missed opportunities51
Printing daily report with the immunization record for that day’s pediatric patients48	Encourage parents to bring immunization record to all clinic visits49
Algorithms for catch-up of patients not on schedule or with incomplete immunizations51	Educating parents even when refusal occur73
Conducting regular assessment of immunization levels with provision of clinic-specific feedback50
Holding team-based quality improvement meetings50
Use of standing orders on immunization in clinics73
Training of health care providers73

HPV: human papilloma virus; EMR: Electronic Medical Record; FOCUS-PDSA: Find Organize Clarify Understand Select–Plan Do Study Act.