Effect of method of defining the active patient population on measured immunization rates in predominantly Medicaid and non-Medicaid practices.

OBJECTIVE: To examine the effect of patient selection criteria on immunization practice assessment outcomes. METHODS: In 3 high- (50%-85%) and 7 low- (<25%) Medicaid pediatric practices in urban eastern Virginia, we assessed immunization rates of children 12 and 24 months old comparing the standard criteria (charts in the active files excluding those that documented the child moved or went elsewhere) with 3 alternative criteria for selecting active patients: 1) follow-up: the chart contained a complete immunization record or the patient was found to be active in the practice through follow-up contact by phone or mail; 2) seen in the past year: the chart indicated that the patient was seen in the practice in the past year; 3) consecutive: patients that were seen consecutively for any reason. RESULTS: Of the 1823 charts assessed in the high- and low-Medicaid practices, follow-up identified 61% and 83% as active patients; 78% and 95% were ever seen in the past year. At 24 months, mean practice immunization rates were lower for standard (70%) than all 3 alternative criteria (78%-86%). Immunization rate differences between standard and alternative criteria were greater in high- (17%-23%) than low-Medicaid practices (5%-13%). CONCLUSION: The standard for practice assessment should be based on a consistent definition of active patients as the immunization rate denominator.

Improving immunization rates in private pediatric practices through physician leadership.

OBJECTIVE: To determine whether a physician-led quality improvement initiative can improve immunization rates in participating private practices. DESIGN: Surveys of private pediatric practices at 6-month intervals over an 18-month period. SETTING: Ten private pediatric practices in Norfolk and Virginia Beach, Va. PATIENTS: Children aged 9 to 30 months attending the private practices. INTERVENTIONS: Practice immunization rates were assessed and presented to practices on 4 occasions at 6-month intervals. A physician leader convened an immunization task force meeting following the first 3 assessments to review practice guidelines, examine data, and discuss practice changes. MAIN OUTCOME MEASURES: Practice immunization rates for patients at age 24 months, with 3- and 12-month immunization rates as secondary outcomes. RESULTS: The mean practice immunization rate at age 24 months increased significantly (P<.05) from 50.9% at baseline to 69.7%. Rates also increased at age 3 months, from 75.5% to 88.9%, and at age 12 months, from 72.9% to 84.6%. The median age at administration of the fourth dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccine decreased (P<.05) from 17.6 to 16.8 months. Physicians also reported making additional changes, including improved record keeping and screening for immunizations at every visit. CONCLUSION: A quality improvement initiative enabling physician leadership can improve preschool immunization practices and coverage levels in pediatric practices.

The purpose and functions of immunization information systems within health care organizations.

Abroad coalition of public and private health care organizations advocate the development of computerized immunization information systems as a key national strategy for achieving and sustaining high immunization coverage levels. However, widespread adoption requires greater awareness of the purpose, functions, and value of an immunization information system within health care organizations. We propose that the purpose of an immunization information system is to increase the efficiency and effectiveness of immunization-related practices and identify 9 potential functions that accomplish this purpose through improving patient care and practice management. When implementing an immunization information system within a practice setting, health care providers must consider technological and organizational issues. Health care providers should also look beyond their particular practice setting and establish public-private partnerships to create a system that links immunization data from all health care providers.