Provider characteristics and behaviors as predictors of immunization coverage.

BACKGROUND: Most studies of immunization behaviors measure adherence to standard immunization practices, relying on surveys without linking reported behaviors to objectively measured immunization rates. This study attempts to close that gap. METHODS: In 1997, pediatric, family, and general providers in Pennsylvania serving children aged < 36 months (N = 251) completed immunization behavior surveys. We linked these responses to patient chart audits for practice-level immunization rates. RESULTS: Immunization rates for our sample fell short of national goals (average up-to-date immunization status at 12 months = 69%). They were significantly higher for pediatricians than for family/general practitioners (78% vs 58%, p < 0.001) and for practices treating > or = 100 children in the past 30 working days than for those treating < 100 children (77% vs 62%, p < 0.001). Behaviors with significant associations to higher immunization coverage were: (1) appropriately giving diphtheria, tetanus toxoids, and pertussis immunization under false contraindications versus withholding it (73% vs 66%, p < 0.05); (2) willingness to give at least four injections at one visit versus fewer injections (74% vs 65%, p < 0.01); and (3) holding immunization in-service training versus no training (71% vs 65%, p < 0.05). However, multivariate analysis showed that only provider specialty remained a significant predictor of coverage. CONCLUSIONS: Pediatricians have higher coverage rates than family/general practitioners. Although pediatricians see more children, the number of immunization-delayed children at 12 months is approximately the same for both provider groups. Therefore, efforts to improve coverage should continue to be directed toward both groups.

Registry-driven, community-based immunization outreach: a randomized controlled trial.

OBJECTIVES: This study evaluated the effectiveness of registry-driven, community-based outreach directed toward children with immunization delays. METHODS: A sample of 1,856 children aged 6 to 10 months was randomly assigned to receive either outreach or no intervention. RESULTS: Children in the outreach group were more likely to receive an immunization during the observation period than children in the control group (61% vs 43%). Outreach was most effective for children with multiple risks, as measured by their immunization record; it was not effective for children whose mothers had received inadequate prenatal care. CONCLUSIONS: Registry-driven outreach can effectively identify high-risk children and bring them to care.

Beneficiary decisionmaking: the impact of labeling health plan choices.

One critical health plan decision concerns choosing an original Medicare plan or a Medicare managed care plan. Evidence suggests that people are confused by the phrase "Original Medicare plan." Using focus group and Q-sort methodology, the authors sought to identify a name for the Medicare fee-for-service (FFS) product. Two key insights were gained. First, participants used the word "Medicare" to name the FFS product. Second, participants did not choose between two plans. Rather, they decided between supplemental insurance and a managed care product. These factors should influence how CMS "brands" not only the FFS product but also the overall Medicare program.

Preventing medical errors: communicating a role for Medicare beneficiaries.

This study used a focus group methodology to examine how Medicare beneficiaries reacted to messages on specific kinds of preventive action, including those adopted by public and private section health organizations. Beneficiaries were asked to rank the messages on their own, and then to discuss their rankings in focus groups. The best-received messages advocated a collaborative patient-provider relationship. They also specified which actions to take, and how to implement them. The authors conclude that public health campaigns to reduce errors need not undermine trust in providers.