Formative Evaluation Results for a Local Public Health QI initiative to Improve Immunization Rates

Quality Improvement (QI) is a widely used tool to enhance organizational performance, but there is little published evidence on the value and impact of QI in public health (RWJF). The Duval County Health Department launched a RWJF supported effort to demonstrate the benefits and lessons learned from implementing QI processes to improve population health in June, 2009. The primary QI population outcome of concern for this project was the relatively low rate of childhood immunizations for clinics predominantly serving low income minority clients in Jacksonville, rates for the 4/3/1/3/3/1 series for children, 19 to 35 months old. The purpose of this QI evaluation project is to: 1) provide formative feedback for implementation, 2) document and disseminate the challenges and obstacles in applying QI processes and 3) document and disseminate the successes that are achieved by using QI processes for improved population health. Our evaluation employs a Mixed Method Design involving: 1) quantitative data on immunizations and factors influencing immunizations, and 2) qualitative data including observations of staff engaged in QI activities and interviews of staff. A public health primary care clinic with low immunization was identified for a pilot QI site, and a well structured PDSA process was implemented with the clinic staff and other key stakeholders serving as a QI team. Immunization rates improved from 74% to 81% in the first months of the project but then leveled off. Major insights for improving the QI efforts within public health settings emerged from this formative evaluation. These insights and resulting changes to the QI processes will be discussed.