Article Figures & Data
Figures
- Figure 1.
Citation flow.
- Figure 2.
Effect of quality improvement interventions on influenza vaccination rates.
CQI = continuous quality improvement; OR = odds ratio.
Note: Forest plot showing pooled odds ratios from random effects meta-analyses. Vaccination rates provided are crude estimates generated by summing patients among studies. Many studies contributing odds ratios for meta-analysis did not provide crude counts.
a Pooled odds ratios from fewer than 3 comparisons are reported but considered insuffi cient for interpretation.
- Figure 3.
Effect of quality improvement interventions on pneumococcal vaccination rates.
CQI = continuous quality improvement; OR = odds ratio.
Note: Forest plot showing pooled odds ratios from random effects meta-analyses. Vaccination rates provided are crude estimates generated by summing patients among studies. Many studies contributing odds ratios for meta-analysis did not provide crude counts.
a Pooled odds ratios from fewer than 3 comparisons are reported, but considered insuffi cient for interpretation. No comparisons involving patient fi nancial incentives were available for meta-analysis.
Tables
The Article in Brief
Jeffrey A. Johnson , and colleagues
Background Vaccines can help prevent influenza and pneumococcal disease, but vaccination rates are low. In this study, researchers review existing evidence to determine the effectiveness of different quality improvement interventions aimed at increasing vaccination rates.
What This Study Found The analysis of 106 studies involving more than 470,000 patients suggests that the best chance for improving vaccination rates may be achieved by (1) shifting vaccine administration from physicians to other members of the primary care team with clear responsibilities for chronic and preventive care and (2) activating patients through personal contact.
Implications
- The impact of these interventions is modest. The authors call on policy makers to temper their expectations of such interventions.
Supplemental Appendixes
Supplemental Appendix A. This appendix contains detailed methods (including the search strategy), and information on excluded and included studies. Exhibit A.1 summarizes recommendations for influenza and pneumococcal vaccination. The search strategy is reported in Exhibit A.2. Exhibits A.3 and A.4 are tables listing excluded studies and reasons for exclusion. Exhibit A.5 contains detailed descriptions of the design, interventions, and results of the included studies. Exhibit B.1 and B.2. These exhibits contain, for each intervention, a forest plot, a table showing each study's performance on the items of the Downs and Black instrument, and a table showing each study's performance on the Cochrane Risk of Bias (ROB) tool. ROB is designed for clinical trials, and was not completed for observational studies. Supplemental Appendix C. Exhibits C.1 and C.3 depict the results of meta-analyses for particular patient outreach strategies for influenza and pneumococcal vaccinations, respectively. Exhibits C.2 and C.4 depict the results of meta-analyses stratified by various team change approaches, for influenza and pneumococcal vaccinations, respectively. Finally, exhibits C.5 (a) and (b) list estimated numbers needed to treat for an additional vaccination, based on pooled intervention odds ratios.
Files in this Data Supplement:
- Supplemental data: Appendix A - PDF file, 118 pages, 205 KB
- Supplemental data: Appendix B - PDF file, 40 pages, 5.5 MB
- Supplemental data: Appendix C - PDF file, 15 pages, 1.4 MB
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