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Quality Improvement


​​​​​Basics in Quality Improvement

    What is Quality Improvement

    ​Quality Improvement (QI) focuses on using a systematic approach to improve patient care. Below you can learn more about QI activities that allow you to measure current immunization rates. Participating in QI activities can help you do the following:- Improve patient outcomes (improve immunization rates)

    1. Improve patients and family satisfaction
    2. Unite your staff in a common goal
    3. Improve office efficiency
    4. Decrease cost​​​​​​

    QI activities start by reviewing current processes, and determining ways to improve.

    Once an area for improvement is identified, establish the following:

    1. AIM: What are we trying to accomplish?- 
    2. MEASURES: How will we know that a change is an improvement?
    3. CHANGES: What changes can we make that will result in an improvement? 

    Answer these question to help ensure your planning is thoughtful.

    In order to test your intervention, you may consider a PLAN – STUDY – DO – ACT cycle. This model is used to rapidly test a change on a small scale, learn from the process, and apply those learnings to another cycle.

    Plan: Make a blueprint for what will change. Set your aim, establish measures, and select your ideas for change. Specify the steps you will take and identify who will be responsible for what, when, where, and how. Try to predict the results of the test.

    Do: Try your change on a small scale – for example, with a few patients and for a short time – and note what happens.

    Study: Evaluate the changes you tried to determine what worked and what did not. Compare the results of the current test with the baseline or previous cycles and the goal.

    Act: Adopt, reject, or modify the change so the next cycle can begin. Will you increase the scope if the results were positive, or plan another test if the results were less than desirable? Decide what you will do differently in the next cycle.*

    *This is from the AAP Education in Quality Improvement for Pediatric Practices (EQIPP) QI Basics course. This course is included with each EQIPP module and provides a foundation for implementing QI projects in your practice. To learn more or to sign up for an EQIPP course, visit:

    Sample PDSA Cycles:

    EQIPP Module

    Improve your practice's immunization rates and earn Part IV Maintenance of Certification Credit with the Education in Quality Improvement for Pediatric Practices Immunization course. Watch the v​ideo​ to learn more. 


    NVAC Standards/Best Practice

    The National Vaccine Advisory Committee (NVAC) Standards for Child and Adolescent Immunization Practices represent the most desirable immunization practices, which pediatricians should strive to achieve. The AAP endorses the NVAC Standards and encourages pediatricians to fully implement the recommendations. In an effort to address implementation challenges, the AAP Childhood Immunization Support Program collects best practices from pediatric offices and shares them for adoption in your office!

    • Maintaining Standards of Excellence: Standard 1 (PDF 195KB) 
      Addresses NVAC Standard #1: Vaccination services are readily available.
    • Maintaining Standards of Excellence: Standard 2 (PDF 198KB)
      Addresses NVAC Standard #2: Vaccinations are coordinated with other healthcare services and provided in a medical home when possible.- 
    • Maintaining Standards of Excellence: Standard 3 (PDF 280KB)
      Addresses NVAC Standard #3: Barriers to vaccination are identified and minimized. 
    • Maintaining Standards of Excellence: Standard 4 (PDF 259KB)
      Addresses NVAC Standard #4: Patient costs are minimized.- 
    • Maintaining Standards of Excellence: Standards 5 & 6 (PDF 191KB)
      Addresses NVAC Standard #5: Health care professionals review the vaccination and health status of patients at every encounter to determine which vaccines are indicated. Also addressesNVAC Standard #6: Health care professionals assess for and follow only medically accepted contraindications.- 
    • Maintaining Standards of Excellence: Standard 7 (PDF 203KB)
      Addresses NVAC Standard #7: Parents/guardians and patients are educated about the benefits and risks of vaccination in a culturally appropriate manner and in an easy-to-understand language.- 
    • Maintaining Standards of Excellence: Standards 8 & 9(PDF 199KB)
      Addresses NVAC Standard #8: Healthcare professionals follow appropriate procedures for vaccine storage and handling. Also addresses NVAC Standard #9: Up-to-date, written vaccination protocols are accessible at all locations where vaccines are administered.
    • Maintaining Standards of Excellence: Standard 10 (PDF 232KB)
      Addresses NVAC Standard #10: Persons who administer vaccines and staff who manage or support vaccine administration are knowledgeable and receive ongoing education. 
    • Maintaining Standards of Excellence: Standards 11 & 13
      Addresses NVAC Standard #11: Healthcare professionals simultaneously administer as many indicated vaccine doses as possible. Also addresses NVAC Standard #13: Health care ​​professionals report adverse events after vaccination promptly and accurately to the Vaccine Adverse Events Reporting System (VAERS) and are aware of a separate program, the National Vaccine Injury Compensation Program (VICP).​

​​Chapter Quality Network

The Division of Chapter Quality Improvement Initiatives facilitates and supports chapter quality improvement projects, including Chapter Quality Network (CQN) learning collaborative.  These projects build chapter capacity to lead improvement efforts with member practices that result in improved care and outcomes at a population level. The Division currently houses three ongoing CQN projects and supports a fourth CQN project that is sponsored by the Department of Child Health and Wellness:

CQN Asthma
CQN US Immunizations
CQN for Mental Health and Adolescent Substance Use (Department of Child Health and Wellness)

Chapter Quality Network U.S. Immunization Project
The Chapter Quality Network (CQN) is pleased to announce the following six AAP chapters   participating in the Childhood Quality Improvement (QI) Immunizations project underway through February 2018.

The immunization project will focus on improving coverage rates for children 19-35 months and reduce missed opportunities to immunize in practice settings.  This QI collaborative follows the Institute for Healthcare Improvement’s Breakthrough Series Model.

CQN Immunization Chapter Project Teams:
California-2 Chapter​

Executive Director: Tomas Torrices, MD
Physician Lead: Edward Curry, MD, FAAP

California-4 Chapter

Executive Director: Jaime McDonald, MPH
Physician Lead: Eric Ball, MD, FAAP

Georgia Chapter

Executive Director: Rick Ward, CAE
Physician Lead: Dixie Griffin, MD, FAAP, Co-Lead Flavia Rossi, MD, FAAP

New Jersey Chapter

Executive Director: Fran Gallagher, MEd
Physician Lead: P. Rad, MD, FAAP, Physician Advisor Steven Kairys, MD FAAP

New York-2 Chapter

Executive Director: Elie Ward, MSW
Physician Lead: Kenneth Bromberg, MD, FAAP

Oklahoma Chapter

Executive Director: Amy Prentice
Physician Lead: Marnie Dunlap, MD, FAAP

CQN works at the practice, chapter and national levels to improve quality of care and outcomes for children at a population level using evidence-based guidelines. The CQN U.S. Immunization project is supported by an independent grant from Pfizer, Inc.

Have a question regarding the CQN U.S. Immunizations project or a future CQN project topic in mind?  We’d love to hear from you!

CQN U.S. Immunization Project Manager
Kristie Marcelle, MSW or call 847-434-7954

Hub and Spoke Initiative

    District Hub and Spoke Initiative Focused on Improving HPV Vaccination Rates

    The American Academy of Pediatrics received funding in 2014 from the Centers for Disease Control and Prevention to improve HPV vaccination rates within regions across the United States through the application of quality improvement (QI) methodology. Through the hub-and-spoke model of improvement, pediatricians across specialties within AAP d​istricts learned quality improvement (QI) methodology then applied it to projects in their own practices and institutions to build state/reg​ional capacity for improvement. The goal was to build a critical mass of pediatricians trained in QI with the goal of improving children's health across a region on any given topic area.

    Over the span of the project period each District in the Academy had the opportunity to participate. Below is a list of District participation by year.

    District IV
    District VI​
    District VII
    District X
    District I
    District II
    District III
    District V
    District VIII
    District IX

    District Quality Improvement Training

    ​The District Hub and Spoke Initiative began with QI trainings occurring with each of the AAP Districts.

    The District QI Training involved district and chapter leadership along with local champions with clinical expertise in immunizations, HPV, and practice imp​​rovement. The training curriculum and worksheets were designed to​ meet districts where they are in their QI journey and provide opportunities for shared learning. Examples of training topics include foundational QI, the model for improvement, measurement, QI tools, and/or sustainability and spread. Specific aims of the training include:

    • ​Promoting the application of QI methods and implementation strategies to district/chapter efforts 
    • Enhancing district and chapter capacity for leading and engaging in improvement initiatives
    • Building lead​ership for QI among districts and chapters​
    Chapter-led Project Aimed to Improve HPV Vaccination Rates

    ​Following the District QI Training, each participating chapter led an HPV vaccination QI project. The intended outcome of these projects was to improve HPV vaccination rates by spreading QI concepts to pediatric practices. Each AAP chapter in the District was eligible to receive funding to focus their efforts in improving:

    • ​Initiation of the HPV vaccine series through a strong provider recommendation and/or
    • Completion of the HPV vaccine series through tools such as reminder/recall.

    Resources Available

    PediaLink Training M​​odules for CME Credit:

    HPV Vaccine Content and Education (resources below are available at

    • ​Sample PDSA Cycles 
    • 9-Valent HPV Vaccine Frequently Asked Questions (FAQs) 
    • Fact Sheets 
    • PowerPoint presentations for clinicians and office staff on a strong recommendation and improving adolescent immunization rates

    Quality Improvement


    Sample Aims and Measures for HPV Vaccination

    1. ​By (Specific Date), improve HPV vaccination series initiation with patients by age 13 by at least 10%. 
      1. ​Measure Definition: % of patients who have documentation that HPV vaccine dose 1 was given by age 13
        1. ​Measure Question: Is there documentation that the patient received dose 1 of the HPV vaccination series?
        2. Measure Calculation: Numerator: # patients in the records examined by age 13 who receive HPV dose 1; Denominator: # of patients in records examined by age 132.
    2. ​ By (Specific Date), improve HPV vaccination series completion with patients by age 13 by at least 10%.1.
      1. Measure Definition: % of patients who have documentation that HPV vaccine dose 3 was given by age 13​
        1. ​​Measure Question:Is there documentation that the patient received all doses of the vaccination series?
        2. ​Measure Calculation: Numerator: # of patients in the records examined age 11-13 who receive HPV dose 3; Denominator: All patients in records examined by age 13 who have already received dose 1
    Resources for Project Participants

    ​Training Session Res​​​ources

    • This webinar provides an overview of EQIPP and QIDA and provides a brief QIDA demo
    • The District IV plenary session, Elements of a Successful and Unsuccessful Vaccine Visit by Dr Jimmy Roberts and Dr Charlene Pope, was videotaped​ and can be accessed at with the password: aap2015
    • District QI Curriculum (Coming soon!)
    • ​ District QI Worksheets (Coming soon!)
    Please sign in to access District documents using your AAP user ID and password
    District I
    District II
    District III​
    District IV
    District V
    District VI
    District VII
    District VIII
    District IX
    District X
    Resources for Chapters Participating in the Umbrella MOC

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