California Immunization Improvement Project
Through the California Immunization Improvement Project, the California Quality Collaborative (CQC) is working with five California care practices to test practical, practice-level strategies for improving childhood and adolescent immunization delivery.
Over the six-month pilot, participating practices will receive individualized technical assistance to identify operational barriers, strengthen immunization workflows, test targeted improvement strategies, and build more reliable systems for ensuring patients receive recommended vaccines.
The project is supported by Blue Shield of California and builds on CQC’s experience helping independent primary care practices implement sustainable quality improvement and population health strategies.
Addressing Operational Barriers to Immunization
Childhood and adolescent immunizations remain a priority across California, yet immunization rates continue to decline. Although vaccine hesitancy is an important consideration, practices also face significant operational barriers that can prevent patients from receiving recommended vaccines.
These barriers may include:
- Incomplete or inconsistent immunization data
- Difficulty identifying patients who are due or overdue
- Missed vaccination opportunities during patient visits
- Inconsistent outreach and follow-up processes
- Limited vaccine appointment availability
- Unclear staff roles and responsibilities
- Variation in how vaccine recommendations are communicated
The California Immunization Improvement Project focuses on helping practices strengthen the systems and workflows needed to deliver immunizations consistently and proactively.
Supporting Practice-Level Improvement
From July through December 2026, CQC will provide participating practices with individualized coaching and shared learning opportunities.
Participating Practices
- Huntington Plaza Pediatrics
- Newport Children’s Medical Group: Fashion Island
- Newport Children’s Medical Group: Costa Mesa
- Pediatric Associates of Sacramento – Pediatrics Medical Associates Howe
- Pediatric Associates of Sacramento – Pediatrics Medical Associates Folsom
Each practice will:
- Assess its current immunization-related capabilities and workflows
- Identify priority operational barriers
- Develop a practice-specific improvement goal
- Test targeted workflow changes
- Use data to monitor implementation and identify opportunities for refinement
- Establish plans to sustain successful changes beyond the pilot period
Because every practice operates differently, improvement strategies will be tailored to each organization’s patient population, staffing model, data capabilities, and operational priorities.
Areas of Focus
The project’s improvement framework addresses five interconnected areas:
- Leadership and Accountability
Establishing clear ownership for immunization improvement and regularly reviewing progress with practice leaders and staff.
- Data and Measurement
Improving access to accurate, actionable immunization information and using data to identify gaps, prioritize patients, and guide improvement activities.
- Standardized Clinical Workflows
Strengthening team roles, point-of-care vaccine assessment, standing orders, and other processes that reduce missed vaccination opportunities.
- Patient Communication and Vaccine Confidence
Supporting consistent, evidence-informed vaccine recommendations and effective conversations with patients and families.
- Outreach and Access
Developing proactive reminder and recall systems, targeted outreach approaches, and scheduling options that make vaccines easier to obtain.
Testing Practical Strategies
Participating practices will select and test changes aligned with their most important operational needs. Potential strategies include:
- Reviewing vaccine status before or during patient visits
- Creating clearly defined immunization roles for staff
- Improving immunization documentation and record reconciliation
- Using patient lists to support targeted outreach
- Strengthening reminder and recall processes
- Offering vaccine-only visits or targeted immunization clinics
- Standardizing vaccine recommendations across the care team
- Beginning vaccine conversations earlier in the immunization schedule
Practices will test changes on a small scale, review what is working, and refine their approach before incorporating successful strategies into routine operations.
How Success Will Be Assessed
CQC will evaluate both the implementation of practice-level improvements and their potential effect on immunization performance.
The evaluation will consider:
- Changes in practice workflows and capabilities
- Adoption and consistency of selected interventions
- Progress on practice-specific improvement measures
- Available childhood and adolescent immunization data
- Practice experiences, barriers, adaptations, and lessons learned
- The ability of practices to sustain improvements after the pilot
Because measurable changes in immunization outcomes may take time, the evaluation will examine both short-term implementation progress and longer-term opportunities for improved performance.
Building a Scalable Model
The 2026 pilot is intended to inform a broader approach to supporting immunization improvement across California.
Lessons from participating practices will be used to develop practical resources, implementation guidance, and recommendations for expanding the model to additional practices and health plan partners. The long-term goal is to establish a scalable, multi-payer approach that aligns support for practices while strengthening immunization delivery across the state.