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

“…5 In addition, written retrospective feedback was shown to be ineffective in improving resident's immunization knowledge levels in resident continuity clinics. 6 One instructional method for learning about pediatric immunizations is through patient-based/experiential teaching. At our institution we rely on the clinical interaction with the patients presenting to the resident continuity clinics to provide a large proportion of the instruction experienced during residency.…”