• William C Livingood, Radwan Sabbagh, Steve Spitzfaden, Angela Hicks, Lucy Wells, Suzannah Puigdomenech, Dale F Kramer, Ryan Butterfield, William Riley, and David L Wood.
• Center for Health Equity & Quality Research, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA. William.Livingood@jax.ufl.edu
• Am J Prev Med. 2013 May 1; 44 (5): 445-52.

BackgroundQuality improvement (QI) is increasingly recognized as an important strategy to improve healthcare services and health outcomes, including reducing health disparities. However, there is a paucity of evidence documenting the value of QI to public health agencies and services.PurposeThe purpose of this project was to support and assess the impact on the outcomes and organizational culture of a QI project to increase immunization rates among children aged 2 years (4:3:1:3:3:1 series) within a large public health agency with a major pediatric health mission.MethodsThe intervention consisted of the use of a model-for-improvement approach to QI for the delivery of immunization services in public health clinics, utilizing plan-do-study-act cycles and multiple QI techniques. A mixed-method (qualitative and quantitative) model of evaluation was used to collect and analyze data from June 2009 to July 2011 to support both summative and developmental evaluation. The Florida Immunization Registry (Florida SHOTS [State Health Online Tracking System]) was used to monitor and analyze changes in immunization rates from January 2009 to July 2012. An interrupted time-series application of covariance was used to assess significance of the change in immunization rates, and paired comparison using parametric and nonparametric statistics were used to assess significance of pre- and post-QI culture items.ResultsUp-to-date immunization rates increased from 75% to more than 90% for individual primary care clinics and the overall county health department. In addition, QI stakeholder scores on ten key items related to organizational culture increased from pre- to post-QI intervention. Statistical analysis confirmed significance of the changes.ConclusionsThe application of QI combined with a summative and developmental evaluation supported refinement of the QI approach and documented the potential for QI to improve population health outcomes and improve public health agency culture.Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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