IntroductionThe receipt rate of hepatitis B virus vaccine among adolescents in the United States is high, while the receipt rate of human papillomavirus vaccine is low. Rates have not been closely studied among refugees, whose home countries have high rates of disease caused by these viruses.MethodsWe examined human papillomavirus and hepatitis B virus immunization rates among 2,269 refugees aged 9 to 26 years who resettled in Massachusetts from 2011 through 2013. This was a secondary analysis of data from their medical screenings. We used binary logistic regression to assess characteristics associated with immunization and bivariate analyses to compare refugee immunization rates with those of the general US population.ResultsForty-five percent of US adolescents aged 13 to 17 years received 1 dose of human papillomavirus vaccine, compared with 68% of similarly aged refugees. Males (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.52–0.74), refugees older than 13 years (aOR, 0.74; 95% CI, 0.60–0.93), and refugees not from Sub-Saharan Africa (aOR, 0.74; 95% CI, 0.59–0.92) were less likely to receive human papillomavirus vaccine, while arrivals in 2012 through 2013 were more likely (aOR, 1.6; 95% CI, 1.3–1.9) than those arriving in 2011. Refugees older than 13 years were less likely to receive 2 doses of hepatitis B virus vaccine (aOR, 0.49; 95% CI, 0.37–0.63) than older refugees.ConclusionSpecialized post-arrival health assessment may improve refugees’ immunization rates.
Low rates of behavioral health (BH) engagement and poor follow-up can exacerbate youth mental health difficulties. Warm handoffs, when a primary care provider (PCP) introduces the patient to the BH care provider in an integrated setting, have been shown to improve the rate of BH follow-up appointments. This 1-year study describes a quality improvement (QI) project conducted at a large, urban pediatric primary care practice, with aims of (a) improving the percentage of warm handoffs performed for pediatric patients referred to behavioral health by 100% and (b) increasing the proportion of warm handoffs completed per primary care provider (PCP) for 60% of all PCPs. Methods: Using QI methods, a multidisciplinary team implemented tests of change via Plan-Do-Study-Act cycles (PDSAs) and completed a run chart of number of warm handoffs to assess performance. A balancing measure was used to determine impact of increased warm handoffs on behavioral health provider's sessions. Results: The percentage of warm handoffs doubled compared to the baseline period (37% vs. 18%), and there were significant differences in follow-up rates between referred patients who received a warm handoff (73.1%) and those who did not (49.5%), regardless of whether the same BH provider conducted the warm handoff and follow-up visit, or whether two different BH providers were involved. Additionally, the
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