A Clinic-Level Approach to Improve Uptake of First COVID-19 Vaccine Dose in Primary Care

This quality improvement initiative aimed to increase first dose of COVID-19 vaccinations during pediatric/adolescent clinic visits. Four plan-do-study-act cycles were performed with creation of eligibility lists and increasing health educator (HE) engagement. Statistical process control analysis assessed vaccine receipt over time. Logistic regression modeling evaluated odds of receipt. Among 6,740 visits, 52.2% of patients were eligible for first COVID-19 vaccine; 17.9% of eligible patients accepted it. First-vaccine improvements from 13.1% to 21.7% were not sustained. Odds of receipt increased in each cycle compared with baseline (1: Odds Ratio=1.99 [95% Confidence Interval 1.49-2.67], 2: OR=2.22 [1.58-3.14]), 3: OR=2.15 [1.51-3.05]), 4: OR=1.48 [1.11-1.96]), and with HE discussion versus no HE discussion (OR=1.64 [1.16-1.90]). First COVID-19 vaccine receipt increased with vaccine-eligible patient lists and HE-initiated discussions, although improvements diminished over time. Health educator versus no HE discussion led to improved vaccinations, supporting further quality improvement research on HE role to improve vaccine uptake.