Adolescents, well visits, and immunizations: can quality improvement move the needle?

Adolescent well-visits and vaccinations are part of the Bright Futures recommendations for well-rounded childcare; however, practices still experience care gaps with these measures. The Pennsylvania Medical Home Program (PA MHP), a network (n = 186) of primary care practices, conducted a quality improvement (QI) initiative to increase adherence to these recommendations. Participants included 12 pediatric primary care practices (urban, suburban, and rural) from the statewide network and 76 practice team members, with 31 practitioners (MD, DO) eligible for MOC Part 4 credits. From January 2018 to January 2019, the PA MHP team conducted educational CME/CEU webinars, one QI boot camp conference, monthly practice QI calls, and ongoing technical support. Key driver diagrams, PDSA cycles, and the Quality Improvement Data Aggregator (QIDA) data tracker were utilized to track this initiative. Our analysis indicated a slight increase in adolescent well-visits and vaccination rates for meningococcal and Tdap. Attendance for adolescent annual well visits in Cycle 3 versus Cycle 1 was statistically significant (P = 0.04). There were no significance differences between males and females in well-visit and vaccination rates. This PA MHP QI initiative focused on increasing adolescent immunizations and well-care visit rates demonstrated moderate success. The role of a learning community in a primary care practice network with a diverse geography, practice demographics and patients, ongoing technical assistance, and emphasis on continuous QI holds promise and value for future work and projects.