Evidence-based vaccination strategies in obstetrics and gynecology settings: Current practices and methods for assessment

Obstetrician-gynecologists have the potential to play an important role in the delivery of immunizations to women. However, despite national recommendations, immunization rates among pregnant women and adults in general remain low. Pragmatic immunization delivery trials are needed to demonstrate how best to deliver vaccines in such settings. We report the development and implementation of 2 novel methodologies for immunization delivery research and quality improvement in such settings. The first was the development and application of a 47-point Immunization Delivery Scale that formally assessed variability among practices in their engagement in a variety of evidence-based practices for improving immunization rates. The second was a covariate-constrained randomization technique - a method for achieving balance between study arms in cluster-randomized trials that is especially applicable to pragmatic trials.. To best achieve meaningful and interpretable findings, we recommend use of these or similar techniques in future immunization research and quality improvement projects in OB/GYN settings.