A Quality Improvement Evaluation Case Study

One Florida county increased immunization rates through a quality improvement initiative.


The Issue:

For decades now, quality improvement (QI) initiatives have been shown to improve health care services and outcomes and to reduce health disparities. Application to the public health sector, however, is only more recent.


About the Study:

These researchers conducted and assessed a QI intervention to improve immunization rates at seven Duval County (Florida) pediatric Medicaid clinics that serve a population that is largely African American (30%) and low-income. The project, supported by the Robert Wood Johnson Foundation, sought to increase immunization rates for children aged 2 years from 75 percent to 90 percent.

The QI team used the plan-do-study-act (PDSA) QI cycle for improvement. The project focused on data-driven decision-making involving everyone in owning the problem and finding solutions. While there was initial resistance to the project as being too large and time-consuming, that changed when the QI focus was shifted to smaller scale, rapid PDSA cycles. Data problems were solved with software to bridge the clinical recordkeeping system and the immunization registry.



At the end of the project (3.5 years,) the Duval County Health Department had achieved a 91 percent up-to-date immunization rate. The project’s success and the involvement of staff had a positive effect on the organization’s use of, and confidence in, QI principles and techniques.