Promoting Adherence to Influenza Vaccination Recommendations in Pediatric Practice

J Prim Care Community Health. 2019 Jan-Dec:10:2150132719853061. doi: 10.1177/2150132719853061.


Objectives: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence.

Methods: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], web-based training [WBT], or CCDSS and WBT [BOTH]).

Results: During the study, 55.8% of children and adolescents received influenza vaccination, which improved modestly during the study period compared with the prior influenza season ( P = .009). Actual adherence to recommendations, including dosing, timeliness, and avoidance of missed opportunities, was 46.4% of patients cared for by the PRACTICE. The WBT was most effective in promoting adherence with vaccination recommendations with an estimated average odds ratio = 1.26, P < .05, to compare between preintervention and intervention periods. Over the influenza season, there was a significantly increasing trend in odds ratio in the WBT arm ( P < .05). Encouraging process improvements and providing longitudinal feedback on monthly rate of vaccination sparked some practice changes but limited impact on outcomes.

Conclusions: Web-based training at the start of influenza season with monthly reports of adherence can improve correct dose and timing of influenza vaccination with modest impact on overall vaccination rate.

Keywords: computerized clinical decision support; influenza vaccination; practice variation; quasi-experimental design; web-based training.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cluster Analysis
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Influenza Vaccines / therapeutic use*
  • Influenza, Human / prevention & control*
  • Male
  • Middle Aged
  • Pediatrics / methods*
  • Pediatrics / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Quality Improvement / statistics & numerical data*
  • United States


  • Influenza Vaccines