Strategy
The Connecticut Department of Public Health (CT DPH) restructured and improved two existing hospital-facing initiatives, a birth hospital coverage report and survey, to meet IQIP’s core requirements.
Challenge
When the Centers for Disease Control and Prevention (CDC) introduced the extension of their Immunization Quality Improvement for Providers (IQIP) program to birth hospitals, CT DPH faced the challenge of translating a model designed for pediatric primary care offices into a setting with differing vaccine workflows, data systems, and clinical context. CT DPH also recognized this as an opportunity to build on existing relationships with and work in birth hospitals to successfully implement IQIP in this setting. As a foundation for quality assurance work, the IQIP process starts with a review of clinic vaccination workflow and baseline vaccine coverage data. Based on this discussion, challenges are identified, and quality improvement strategies are selected.
Rather than introducing IQIP to birth hospitals as a standalone process, CT DPH restructured and improved two existing hospital-facing initiatives, a birth hospital coverage report and survey, to meet IQIP’s core requirements. The first initiative, annual feedback on hospitals’ rate of on-time Hepatitis B birth dose administration, provided rates without text or visualizations. The second, the Annual Birth Hospital Questionnaire, was outdated and did not capture vaccine workflow systematically. CT DPH integrated both into a single, QI-focused IQIP visit.
Solution
CT DPH’s goal was to design this single, integrated visit that fulfilled IQIP’s core requirements. The integration had three primary objectives:
- To develop the CT Birth Hospital Annual Immunization Report with visualizations and supporting documentation
- To update and modify the Annual Birth Hospital Questionnaire to meet IQIP requirements and to expand to capture information that would be useful to CT DPH, ensuring that the questionnaire gathered actionable data to inform program planning, monitor hospital practices, and guide future quality improvement efforts
- To create a resource for conducting integrated birth hospital IQIP visits
The Annual Birth Hospital Questionnaire was modernized to an online form and modified to collect information on vaccination policies and procedures, IIS enrollment, birth certification processes, and IQIP workflow assessments and action items. The new CT Birth Hospital Annual Immunization Report was created with 2025 data and distributed to Connecticut birth hospitals. Staff were trained in how to administer the updated questionnaire and how to interpret the coverage data presented in the report. Staff then conducted these integrated IQIP visits with CT birth hospitals.
Outcome
CT DPH successfully integrated birth hospitals into IQIP because they built on existing infrastructure and longstanding relationships with birth hospitals rather than introducing a parallel process. The creation of the automated CT Birth Hospital Annual Immunization Report and revision of the Annual Birth Hospital Questionnaire allowed CT DPH to seamlessly design a single visit that covered a discussion of vaccination coverage, workflow, policies and procedures, and QI strategies.
The report allowed visualized HBV vaccination data to guide IQIP’s coverage goal and strategy discussions without the need for IIS enhancement. The redesign of the Annual Birth Hospital Questionnaire to collect detailed information about vaccination guidelines and policies allowed for the straightforward integration of IQIP workflow and action items. The consolidation of workflows reduced burden on hospitals while increasing the depth of information collected, as merging three touchpoints into one annual visit meant hospitals were more engaged thanks to fewer total interactions, a novel model that other jurisdictions could replicate when expanding IQIP to birth hospitals.
Several jurisdictions and CDC have demonstrated interest in replicating CT DPH’s model to improve IQIP in this critical setting. Furthermore, there has been initial buy-in for QI work from the birthing hospitals, who have requested more frequent data reporting from CT DPH so they can monitor how this work is impacting vaccination rates. In response to these requests, a mid-year CT Birth Hospital Report summarizing HBV and RSV administration data for the first half of 2026 is in development with a target distribution date of October 2026. At that time, a survey will also be distributed to participating hospitals to assess the broader acceptability of the integrated visit process.
Together, the indicators of hospital engagement and interest from other jurisdictions suggest that CT DPH’s model offers proof of concept for implementing IQIP into birth hospitals, one that other jurisdictions and CDC can adapt to strengthen QI work and HBV birth dose coverage on a national scale.
Supplemental Materials