Does a data-enabled Quality Improvement programme improve timeliness and equity of childhood immunisations across North East London?
Problem
Immunisation rates in London are the lowest in England and have become worse during the pandemic(1). Children living in deprived areas and from Black and Mixed ethnic backgrounds are less likely to be fully protected. Call and recall systems in primary care settings are effective at improving immunisation coverage, however it is unclear whether they also improve timeliness and equity.In February 2022, the Clinical Effectiveness Group (CEG) launched a quality improvement (QI) programme in North East London (NEL). It aims to increase the percentage of children completing their primary immunisations by 8 months and receiving first measles, mumps and rubella (MMR) by 18 months and to reduce inequalities in timeliness. It comprises a novel purpose-built call and recall tool [tinyurl.com/3wxp87b4] which practice teams use to prioritise appointments according to immunisation timeliness, ensuring vulnerable children are contacted first. Practices receive 1:1 support from CEG facilitators to download the tool and use it effectively, alongside online instructional resources.1. Firman N, Marszalek M, Gutierrez A, et al Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in North East London: a longitudinal study using electronic health records. BMJ Open 2022;12:e066288. doi:10.1136/bmjopen-2022-066288
Approach
A mixed methods evaluation of this programme will be carried out in 2023. The quantitative component comprises an interrupted time series comparing the percentage of children receiving their 1st MMR by 18 months and 1st DTaP by 6 months in the pre-, implementation and post-implementation periods. The qualitative component uses a ‘Think Aloud’ exercise and semi-structured interviews with practice teams to assess feasibility and sustainability of the tool. A public engagement group was convened to understand parental perspectives.
Findings
Preliminary analyses demonstrate that 87% of NEL practices have downloaded the tool and 42% have been visited by a CEG facilitator. The percentage of children receiving MMR by 18 months increased by 3.1% from 82.2% to 85.3% between September 2021 and September 2022 for practices using the tool and receiving a facilitation visit. Parents raised the importance of access to local and flexible services and of sending relevant information to diverse ethnic communities. The first half of the qualitative evaluation has been completed and analysis of the Think Aloud component of the evaluation will be completed by June 2023.
Consequences
These interim findings highlight the importance of facilitation as part of a data-enabled QI programme however a full evaluation is required to confirm this. Implementation has been disrupted by NHS reorganisation and the London Polio Booster Campaign, and a Local Incentive Scheme to incentivise practices has yet to be delivered. Qualitative evaluation of pilots is planned in other London areas in 2023.