Provider vaccine performance feedback did not increase flu vaccine uptake among Veterans at the Atlanta VA

What was the challenge?

The Department of Veterans Affairs (VA) National Center for Health Promotion and Disease Prevention promotes vaccinations for Veterans, in line with the Centers for Disease Control recommendations. Despite the availability of free flu vaccines at VA health care facilities, Veterans’ rates of vaccination for flu and many other adult vaccinations fall below the Healthy People 2020 targets of 70%.

What was the program change?

The Atlanta VA and OES developed a performance feedback intervention, including four monthly performance feedback emails, a leaflet with evidence-based practices to increase flu vaccination rates and an online Frequently Asked Questions document. The performance feedback included flu vaccination rates for each provider group, or Patient Aligned Care Team (PACT). Specifically, it contained each PACT’s current and past flu vaccination rates, the number of unvaccinated patients assigned to the PACT, and peer vaccination rates in the form of the “Top 10%” of PACTs at the Atlanta VA. It also highlighted the Healthy People 2020 vaccination targets for adults aged 18-64 (i.e., 70%).
Figure 1: The performance feedback email included current and past vaccination rates for each provider group.

How did the evaluation work?

The efficacy of the provider-based monthly performance feedback intervention was tested with a cluster-randomized controlled trial. The Atlanta VA identified 82 PACT clusters which did not have overlapping healthcare providers. These PACTs participated in the study. A total of 66,725 patients who were not vaccinated at the start of the study period were randomized into the intervention (41 PACTs) and a business-as-usual condition (41 PACTs). The randomization process was blocked by PACT size and location.

Figure 2: The leaflet sent to providers with evidence-based practices to increase flu vaccination rates.

What was the impact?

The results suggest that there was no statistically significant difference in flu vaccination rates between patients in treatment and control PACTs one month following the performance feedback treatment. We observed a vaccination rate of 13.3% among PACTs that received the performance feedback intervention and 13.5% among PACTs that did not during the study period (p = 0.899, 95% CI [-0.009, 0.014])


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Project Type

Program Change and Evaluation


Veterans Affairs




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