Strategy
Expand the Immunization Quality Improvement Program (IQIP) process to include adults and create an opportunity to increase quality improvement work focused on adult immunizations.
Challenge
Vermont is a universal state, which means that the state purchases both private stock and VFC stock of vaccines at the federally contracted VFC prices. As of January 2024, Vermont has 185 practices enrolled in the VFC program statewide. Less than 20% of the VFC enrolled sites are pediatric offices, most are family practice sites. Family practice offices typically see adults, occasionally serving children and teens. In these settings, quality improvement processes would not be effective without the inclusion of both adult and childhood immunization rates.
Solution
For VFC-enrolled practices that served children and adults, the Vermont Department of Health (VDH) shared child, teen, and adult coverage rates when conducting IQIP visits. Vermont does require all healthcare providers and insurers to report vaccine doses administrated to the VDH. VDH started incorporating adult rates into their IQIP process in June 2022. The goal was to increase adult immunization quality improvement engagement with family practice providers. The objective for the first year was for 100% of family practices who participate in IQIP to have adult coverage incorporated into their IQIP cycle. The VDH had to develop new forms, talk with their IIS department on how to pull adult coverage rates and conduct training with their IQIP consultants. IQIP consultants asked practices to consider a holistic lens when going through the IQIP process, including assessing differences between pediatric and adult processes during the vaccination workflow assessment.
This intervention required significant time commitment from the VDH staff. The new forms had to be modified by the adult immunization coordinator to include adult coverage rates. The adult coordinator, IQIP coordinator, and IQIP consultants had to receive training. The immunization registry team helped develop training and provided additional context to adult vaccination coverage rates when there were gaps in available data. Other than staff time, there were no additional costs associated with this intervention.
Outcome
Based on the questions received from the IQIP visits, VDH was able to develop additional resources for providers. Expanding the IQIP process to include the discussion of vaccine workflow for adults and adult coverage rates opened up new partnership opportunities for IQIP consultants. Consultants were asked to return to offices for additional training on adult immunization best practices. As part of the relationships established through the IQIP process, the IQIP consultant provided technical assistance and resources on changes in adult immunization recommendations.
Supplemental Resources