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.

Primary care strategies to improve childhood immunisation uptake in developed countries: systematic review

“…Usual care (control group) vs.2. Practice-based continuing medical educationImmunisation rates at 30 months post randomization 1 vs. 2 net change 0.6% (significance not reported)Sinn et al 49 Not reportedTen paediatric group practices, Virginia Beach, Virginia, USA; children aged 9–30 monthsBefore and after trial211. Usual care (control group) vs.2.…”

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.…”

Increasing Immunization Coverage

“…Recent research has demonstrated that physicians can take specific and practical steps to improve their practices' effectiveness in immunizing children. 10,11 Similarly, applied research has identified approaches that can be used by health plans, public health departments, and state and federal government agencies to support improvements in the vaccine delivery system at the health care delivery and population levels. 12 The Task Force on Community Preventive Services, convened by the US Department of Health and Human Services with support from the Centers for Disease Control and Prevention, analyzed the peerreviewed published evidence on interventions designed to improve the timely immunization of children and adults.…”