Tennessee: The Tennessee Immunization Program developed a monthly report, coined the “3-Star Report,” as a continuous quality improvement measure for local health departments (LHD) aimed at increasing bundled administration of Tdap, Men-ACWY, and HPV vaccines during the same visit. The 3-Star Report evaluates the number of preteen vaccines given at immunization visits of VFC-eligible children aged 11-13 years who received a Tdap, Men-ACWY, and/or an HPV vaccine at a LHD. Visits are categorized as 1-Star (1 vaccine given), 2-Star (2 vaccines given), or 3-Star (all 3 given). Each month, data are extracted from the Patient Tracking and Billing Management Information System and staff run the report and distribute it to relevant regional and state public health leadership. Regional and LHDs use the report in a variety of ways – the immunization program does not dictate how the report is used. The report has been correlated with increases in 3-Star visits and the corresponding decreases in non-HPV 1-Star visits each summer during the back to school rush.