Impact of Resident Feedback on Immunization Outcomes

Abstract

To investigate the effect on immunization levels of retrospective written feedback to residents regarding missed immunization opportunities. Design: Randomized trial with control group. Setting: Pediatric resident continuity clinic in an urban hospital-based primary care clinic. Participants: Thirty-two postgraduate level 2 and postgraduate level 3 pediatric residents. Intervention: Monthly retrospective written feedback mailed to residents detailing their missed immunization opportunities and appointment failure rates over a 12month period beginning in February 1997. Main Outcome Measures: The immunization level of 2-year-old children in the resident clinic was the main outcome of interest. Secondary outcomes included missed immunization opportunity rates and appointment failure rates. Results: Postintervention immunization levels were 71.4% (95% confidence limits [CLs]: 63.2%, 78.7%) for patients from the intervention group and 68.5% (95% CLs: 60.8%, 75.4%) for patients from the control group. The immunization level for patients of both groups who had fewer than 2 visits during the second year of life was 47.2% (95% CLs: 38.2%, 56.3%). This compares with an immunization level of 78.1% (95% CLs: 66.0%, 87.5%) for patients from both groups who had 2 visits during the second year of life, and with an immunization level of 88.2% (95% CLs: 81.0%, 93.4%) for patients of both groups who had more than 2 visits during the second year of life (PϽ.001). Conclusions: In this setting, written retrospective feedback to residents was an ineffective strategy for improving immunization levels. Adequate follow-up during the second year of life is critical in achieving high immunization levels.

Interventions to increase pediatric vaccine uptake: An overview of recent findings

“…Tracking systems are computer mechanisms to identify children who have not been seen at a practice recently and/or are not up-to-date on preventive care. 31 As tested via RCT and other rigorous designs (e.g., before-after trials), provider education and feedback have shown inconsistent effects on immunization rates; 56,[76][77][78][79][80] however, when implemented in concert with other strategies as part of a multicomponent intervention, provider education and feedback have been shown to be very effective, improving rates by up to 47 percentage points over 6-month to 2-year periods. 32,34,35,52,53,[81][82][83] Additionally, the "AFIX" (Assessment, Feedback, Incentives, and eXchange of information) framework is an example of a multicomponent provider-based intervention modeled after a program in the state of Georgia that improved pediatric immunization coverage in public clinics from 40% to 91% from 1986 to 2001.…”

An Evaluation of Pediatric Residency Education in Conveying Immunization Knowledge

“……”