Improving immunization rates in a hospital-based primary care practice.

OBJECTIVE: We implemented a quality improvement initiative aimed at reaching a 95% immunization rate for patients aged 24 months. The setting was a hospital-based pediatric primary care practice in Boston, Massachusetts. We defined immunization as full receipt of the vaccine series as recommended by the Centers for Disease Control and Prevention. METHODS: The initiative was team-based and structured around 3 core interventions: systematic identification and capture of target patients, use of a patient-tracking registry, and patient outreach and care coordination. We measured monthly overall and modified immunization rates for patients aged 24 months. The modified rate excluded vaccine refusals and practice transfers. We plotted monthly overall and modified immunization rates on statistical process control charts to monitor progress and evaluate impact. RESULTS: We measured immunization rates for 3298 patients aged 24 months between January 2009 and December 2012. Patients were 48% (n = 1576) female, 77.3% (n = 2548) were African American or Hispanic, and 70.2% (n = 2015) were publicly insured. Using control charts, we established mean overall and modified immunization rates of 90% and 93%, respectively. After implementation, we observed an increase in the mean modified immunization rate to 95%. CONCLUSIONS: A quality improvement initiative enabled our pediatric practice to increase its modified immunization rate to 95% for children aged 24 months. We attribute the improvement to the incorporation of medical home elements including a multidisciplinary team, patient registry, and care coordination.

Formulation of multiple choice questions as a revision exercise at the end of a teaching module in biochemistry.

The graduate medical students often get less opportunity for clarifying their doubts and to reinforce their concepts after lecture classes. Assessment of the effect of MCQ preparation by graduate medical students as a revision exercise on the topic "Mineral metabolism." At the end of regular teaching module on the topic "Mineral metabolism," graduate medical students were asked to prepare the stems of 15 MCQs based on the four discriminators given for each. They were told that one of the discriminators could be the answer for the MCQ and the remaining three could be the distracters. They were further guided in their task by providing few key word(s) in the stem of the expected MCQ. In the first phase of the exercise, the students attempted the MCQ preparation individually without peer consultation. In the second phase, the students participated in small group discussion to formulate the best MCQs of the group. The effects on low, medium, and high achievers were evaluated by pre and post-tests with the same set of MCQs. Both the individual endeavor in Phase 1 and small group discussion in Phase 2 for the formulation of MCQs significantly contributed to the gain from the exercise. The gains from the individual task and from small group discussion were equal among the different categories of students. Both phases of the exercise were equally beneficial for the low, medium, and high achievers. The high and medium achievers retained the gain from the exercise even after 1 week of the exercise whereas the low achievers could not retain the gain completely. Formulation of MCQs is an effective and useful unconventional revision exercise in Biochemistry for graduate medical students.