Assessment and Feedback Tools

Step 2: Deliver

Now that you have PREPARED, you are ready to deliver feedback. Feedback sessions are designed to last about 60-90 minutes and have 7 steps. We give you a suggested length of time to spend on each step, but sessions should be tailored to the needs and interest of each clinic.  Use the presentation slides, in either a webinar or in-person consultation, to guide you through the steps.

Materials for feedback sessions

Communicate the rationale for quality improvement (10 minutes)

Introduce the quality improvement (QI) approach and explain the focus on HPV vaccination.

Give a clear explanation for what the program should accomplish. Participants should understand that they are responsible for conducting QI activities and that you will provide follow-up coverage estimates. Highlighting low HPV vaccine coverage is also important because not all clinicians understand the extent of the problem or feel urgency about addressing it.

Suggested script

  • This is a quality improvement program. Today’s visit is a chance to make a plan for improving adolescent immunization in your clinic. You can think of it as a mini-experiment.
  • I’m going to share a report that shows how your clinic is currently doing immunizing its adolescent patient population. Then, we’ll set a goal for improvement. We’ll talk about ways to meet that goal, and I’ll ask you to share our plan with others in the clinic. In a few months, I’ll send you an updated report, and at that point, we can see if the improvement plan worked.
  • We’ll talk about all three adolescent vaccines today, but we’re going to focus on HPV vaccine. We’re concerned about HPV vaccination because far fewer adolescents get HPV vaccine than Tdap or meningococcal vaccines. We’re missing a really important opportunity to protect kids from cancer. That’s why improving HPV vaccine coverage is a priority for our state.

Set the context for quality improvement (10 minutes)

Invite the participant’s perspective on the clinic’s current adolescent immunization program.

The goal of the consultation is to engage providers and staff as partners in QI. Beginning the consultation with an open-ended inquiry encourages a two-way conversation. This approach also allows the participants to share information that may be used to tailor the session. The focus of Step 2 should be on listening and asking clarifying questions; devising a plan for quality improvement will come later.

Suggested script

  • Tell me about your clinic’s approach to vaccinating adolescents.
  • What are your strengths in this area? What challenges do you face?

Share the Report Card (15 minutes)

Highlight the problem of low HPV vaccine coverage and set a baseline for measuring improvement.

Communicating the problem is important because some clinicians view low coverage as normal for this vaccine. Sharing coverage estimates also gives clinicians a baseline they can use to measure the success of their QI efforts. The goal of this section of the consultation is to motivate rather than discourage.

Strategies to promote collaboration and avoid blame include: acknowledging limitations in IIS data, inviting reactions and questions about the report, and recognizing high levels of coverage for other vaccines.

Suggested script

  • This is a report that shows the percentage of kids in your clinic who have gotten each of the adolescent vaccines. Here we see patients ages 13 through 17, so these are kids who should be up-to-date on all three vaccines. We calculated these estimates using records in our state’s immunization registry. We know that registry data are sometimes incomplete, but they can give us a good starting place for understanding which vaccines need the most attention.
  • Do you have any questions about the report? Do these estimates match what you know about adolescent immunization in your clinic?
  • You can see from the report that your clinic is doing pretty well with Tdap and meningococcal vaccines. You’re getting close to the national goal of 80% coverage. But for HPV vaccine, only X% of girls and Y% of boys are vaccinated. We really need to get these numbers up.

Set a measurable goal for improving HPV vaccine coverage (5 minutes)

Motivate improvement efforts by showing providers how many adolescent patients they need to vaccinate to improve the clinic’s coverage.

Stating the goal as a specific number of patients will help personalize your QI efforts and convey the scope of the project. Providing feedback at 3 months gives providers an opportunity to adjust their improvement efforts if they are not making the expected progress.

Suggested script

  • Over the next 6 months, research suggests that a typical clinic will deliver the first dose of HPV vaccine to about 5% of all 11- to 12-year-old patients in the practice. We know you can do better! We’d like you to aim for vaccinating 15% of your 11- to 12-year-old and 13- to 17-year-old patients.
  • We think this goal is achievable. As you can see, the total number of HPV vaccine doses in question is modest. According to the state’s vaccine registry, you have [number] 11- to 12-year-old patients. To reach your quality improvement goal, your clinic would need to deliver the first dose of HPV vaccine to [number] patients in this age range over the next 6 months.
  • We’re going to be using this immunization report card to track your progress. I’ll get back in touch with you in 3 months and in 6 months to let you know how many of your patients have gotten the first dose of HPV vaccine since this meeting.

Select quality improvement strategies (15-20 minutes)

Discuss the goal of increasing provider recommendation for HPV vaccine as the most effective strategy for increasing coverage and complete the CDC’s Site Visit Questionnaire.

One of the reasons HPV vaccine coverage is low is that some healthcare providers do not recommend the vaccine as strongly or consistently as other vaccines. This is the time to talk to providers about how they recommend the vaccine to their patients. Our research shows that announcements, like the one shown in the Immunization Report Card, work best.

This is also a good time to complete the CDC’s Site Visit Questionnaire. This will help fulfill your CDC requirements for an AFIX visit. It is also a useful tool for starting a conversation about action steps to meet the QI goal.

Suggested script

  • The best way to increase your clinic’s HPV vaccine coverage is for providers to recommend the vaccine more often and more effectively. We want to make sure that all 11- and 12-year-old patients get a recommendation. It’s important to treat HPV vaccine just like other adolescent vaccines. A brief, straightforward approach for same-day vaccination works best.
  • I would like for you to share this report with all the vaccine providers in your clinic. Let them know that their recommendation is important to families and the key to improving HPV vaccine coverage.
  • Now we’re going to fill out a questionnaire about immunization best practices. Along with increasing provider recommendations, we may be able to find a second strategy to raise your HPV vaccine coverage. The section on reducing missed opportunities is especially important.

Create an action plan (10-20 minutes)

Make a plan to distribute copies of the clinic’s Immunization Report Cards; collect contact information for all providers and staff with a role in vaccine provision; and identify other ways to share the report card, goals, and QI strategies with clinic staff.

Use the Action Plan to choose secondary QI strategies to meet challenges specific to each clinic. Consultations rely primarily on the provider or staff member leading the project to reach out to others in the clinic. That person can share information about the project in forums like weekly staff meetings, and can use the Immunization Report Card to convey key points. If email is not a good way to share report cards and other QI information, work with the provider to find other strategies like fax.

Suggested script

  • To get everyone in your clinic involved in this project, we need to share the report with other providers and staff. Here are copies of your Immunization Report Card that I’d like you to give to all staff who have a role in adolescent vaccination.
  • I’d also like to collect email addresses and fax numbers for providers and staff so I can help you get the message out.
  • What are other opportunities to share information about the project? For example, making a short presentation at a regular staff meeting is a great way to get the word out.

Help providers get CME credit (optional activity)

Give providers information about how to claim their CME credit.

If you have certified your feedback session for CME credit, providers that participated in the entire session are eligible to claim credits. Most CME accrediting organizations require providers to complete an evaluation of the educational session. You can administer this evaluation in writing or through an online survey. Whichever you choose, after completing the evaluation, you will need to provide participants with a certificate of completion. Many CME crediting organizations have templates that you can use.

Your CME evaluation tool is also a convenient way to collect other data from providers. Consider whether you plan to evaluate your QI efforts. Combining your CME evaluation with other QI evaluation questions will save providers time by consolidating your data collection efforts.