Improving Immunization Rates in Private Pediatric Practices Through Physician Leadership

Abstract

To determine whether a physician-led quality improvement initiative can improve immunization rates in participating private practices. Design: Surveys of private pediatric practices at 6-month intervals over an 18-month period. Setting: Ten private pediatric practices in Norfolk and Virginia Beach, Va. Patients: Children aged 9 to 30 months attending the private practices. Interventions: Practice immunization rates were assessed and presented to practices on 4 occasions at 6-month intervals. A physician leader convened an immunization task force meeting following the first 3 assessments to review practice guidelines, examine data, and discuss practice changes. Main Outcome Measures: Practice immunization rates for patients at age 24 months, with 3-and 12-month immunization rates as secondary outcomes. Results: The mean practice immunization rate at age 24 months increased significantly (PϽ.05) from 50.9% at baseline to 69.7%. Rates also increased at age 3 months, from 75.5% to 88.9%, and at age 12 months, from 72.9% to 84.6%. The median age at administration of the fourth dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccine decreased (PϽ.05) from 17.6 to 16.8 months. Physicians also reported making additional changes, including improved record keeping and screening for immunizations at every visit. Conclusion: A quality improvement initiative enabling physician leadership can improve preschool immunization practices and coverage levels in pediatric practices.

Utilizing Peer Academic Detailing to Improve Childhood Immunization Coverage Levels

“…First, RITE involved only one onsite educational visit. Current medical literature suggests that multiple in-office visits are necessary to induce substantial physician behavior change (Briss et al, 2000;Margolis et al, 2004;Simon et al, 2005;Sinn et al, 1999). Similarly, educational studies report reinforcement visits can double the effect of an intervention (Soumerai & Avorn, 1990).…”

Improvement in Provider Immunization Knowledge and Behaviors Following a Peer Education Intervention

“…Reviews of the medical literature also reveal that interventions using physician leadership or opinion leaders produce positive effects in physician performance regarding disease prevention and, specifically, childhood immunizations. 27,37 We expanded this model to include 3 peer educators reflecting the different types of staff in pediatric and family practices. As reported in other studies, including the entire staff in the decision-making process and tailoring strategies to the needs of the practice improved adherence to office guidelines, including those regarding immunizations.…”

Compliance With National Immunization Guidelines for Children Younger Than 2 Years, 1996-1999

“…The implementation of immunization registries (either locally or nationally) and clinical intervention or feedback systems, especially ones paying special attention to minimal age requirements and between-dose intervals, are important steps to be considered in reducing immunization errors. [29][30][31][32][33][34][35] Poor patient record tracking and availability, insufficient provider knowledge regarding vaccine contraindications and immunization status, having Ͼ1 provider administering immunizations, and the complexity of current immunization guidelines have been shown to contribute to immunization errors. 30,31,36 At each HMO involved in this study, reminder systems, registries, and other efforts to reduce immunization errors were implemented to varying degrees during the study period.…”