Pediatrics
June 2016, VOLUME 137 / ISSUE 6
http://pediatrics.aappublications.org/content/137/6?current-issue=y

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Articles
Immunization Data Exchange With Electronic Health Records
Melissa S. Stockwell, Karthik Natarajan, Rajasekhar Ramakrishnan, Stephen Holleran, Kristen Forney, Angel Aponte, David K. Vawdrey
Pediatrics Jun 2016, 137 (6) e20154335; DOI: 10.1542/peds.2015-4335
Abstract
OBJECTIVE: To assess the impact of exchange of immunization information between an immunization information system (IIS) and an electronic health record on up-to-date rates, over-immunization, and immunization record completeness for low-income, urban children and adolescents.
METHODS: The New York City Department of Health maintains a population-based IIS, the Citywide Immunization Registry (CIR). Five community clinics in New York City implemented direct linkage of immunization data from the CIR to their local electronic health record. We compared immunization status and overimmunization in children and adolescents 19 to 35 month, 7 to 10 year, and 13 to 17 year-olds with provider visits in the 6-month period before data exchange implementation (2009; n = 6452) versus 6-months post-implementation (2010; n = 6124). We also assessed immunization record completeness with and without addition of CIR data for 8548 children and adolescents with visits in 2012–2013.
RESULTS: Up-to-date status increased from before to after implementation from 75.0% to 81.6% (absolute difference, 6.6%; 95% confidence interval [CI], 5.2% to 8.1%) and was significant for all age groups. The percentage overimmunized decreased from 8.8% to 4.7% (absolute difference, −4.1%; 95% CI, −7.8% to −0.3%) and was significant for adolescents (16.4% vs 1.2%; absolute difference, −15.2%; 95% CI, −26.7 to −3.6). Up-to-date status for those seen in 2012 to 2013 was higher when IIS data were added (74.6% vs 59.5%).
CONCLUSIONS: This study demonstrates that data exchange can improve child and adolescent immunization status. Development of the technology to support such exchange and continued focus on local, state, and federal policies to support such exchanges are needed.

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Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial
Linda Y. Fu, Kathleen Zook, Janet A. Gingold, Catherine W. Gillespie, Christine Briccetti, Denice Cora-Bramble, Jill G. Joseph, Rachel Haimowitz, Rachel Y. Moon
Pediatrics Jun 2016, 137 (6) e20154603; DOI: 10.1542/peds.2015-4603
Abstract
OBJECTIVE: New emphasis on and requirements for demonstrating health care quality have increased the need for evidence-based methods to disseminate practice guidelines. With regard to impact on pediatric immunization coverage, we aimed to compare a financial incentive program (pay-for-performance [P4P]) and a virtual quality improvement technical support (QITS) learning collaborative.
METHODS: This single-blinded (to outcomes assessor), cluster-randomized trial was conducted among unaffiliated pediatric practices across the United States from June 2013 to June 2014. Practices received either the P4P or QITS intervention. All practices received a Vaccinator Toolkit. P4P practices participated in a tiered financial incentives program for immunization coverage improvement. QITS practices participated in a virtual learning collaborative. Primary outcome was percentage of all needed vaccines received (PANVR). We also assessed immunization up-to-date (UTD) status.
RESULTS: Data were analyzed from 3,147 patient records from 32 practices. Practices in the study arms reported similar QI activities (∼6 to 7 activities). We found no difference in PANVR between P4P and QITS (mean ± SE, 90.7% ± 1.1% vs 86.1% ± 1.3%, P = 0.46). Likewise, there was no difference in odds of being UTD between study arms (adjusted odds ratio 1.02, 95% confidence interval 0.68 to 1.52, P = .93). In within-group analysis, patients in both arms experienced nonsignificant increases in PANVR. Similarly, the change in adjusted odds of UTD over time was modest and nonsignificant for P4P but reached significance in the QITS arm (adjusted odds ratio 1.28, 95% confidence interval 1.02 to 1.60, P = .03).
CONCLUSIONS: Participation in either a financial incentives program or a virtual learning collaborative led to self-reported improvements in immunization practices but minimal change in objectively measured immunization coverage.

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Influenza in Infants Born to Women Vaccinated During Pregnancy
Julie H. Shakib, Kent Korgenski, Angela P. Presson, Xiaoming Sheng, Michael W. Varner, Andrew T. Pavia, Carrie L. Byington
Pediatrics Jun 2016, 137 (6) e20152360; DOI: 10.1542/peds.2015-2360

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Commentaries
Immunization Delivery and Policy as an Ongoing Model for Systems Improvement
Simon J. Hambidge
Pediatrics Jun 2016, 137 (6) e20160962; DOI: 10.1542/peds.2016-0962
Initial text
Immunization delivery has long served as a model of the interface between health care and public health. The article by Stockwell et al in this issue of Pediatrics1 illustrates the power of this interface.
The authors studied the impact of a bidirectional exchange of pediatric immunization information between an electronic health record in a large urban ambulatory care network and a citywide immunization information system. They found that immunization up-to-date status increased in all age groups by 81.6% after implementation of the exchange. Importantly, the percent of overimmunized children decreased from 8.8% to 4.7% and was especially pronounced in adolescents (16.4% overimmunized preimplementation to …