Methodological Issues in Determining Rates of Childhood Immunization in Office Practice

Darden, Paul M.; Taylor, James A.; Slora, Eric J.; Hasemeier, Cynthia M.; Asmussen, Linda; Recknor, Julie C.; Wasserman, Richard C.

doi:10.1001/archpedi.1996.02170350029004

Cited by 31 publications

(10 citation statements)

References 11 publications

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“…Research has demonstrated the important effect of different methodologies on the measurement of immunization coverage. [23][24][25][26][27] In particular, the limitations of using parental report have been well documented for immunization assessments, and a similar issue probably exists for lead screening. The use of medical record audits in this study overcomes that limitation and may partially explain the higher screening rates.…”

Section: Discussionmentioning

confidence: 99%

A Statewide Assessment of Lead Screening Histories of Preschool Children Enrolled in a Medicaid Managed Care Program

et al. 2001

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ABSTRACT. Objectives. Despite the prominence of lead poisoning as a public health problem, recent Government Accounting Office reports indicate that only one fifth of children who are covered by Medicaid have been screened for lead poisoning. The purpose of this study was to examine the lead screening histories of children who were enrolled in a statewide, Medicaid managed care plan to determine the relative impact of the type of primary care provider site and family sociodemographic characteristics on the likelihood of being screened. The study also examined the prevalence of and risk factors for lead poisoning of children who had been screened.Methods. A random sample of 2000 preschool-age children was chosen from those who were enrolled continuously in the statewide, expanded, Medicaid managed care program for a 1-year period and between the ages of 19 and 35 months at the end of that year. Sociodemographic characteristics and lists of primary care providers were obtained from administrative data sets. Medical record audits at primary care provider sites were performed to obtain the lead screening histories of the children, including test dates and results.Results. Data on 1988 children were used for study analyses, and 80% of these children had at least 1 documented blood lead level. Children whose primary care provider was an office-based physician were less likely to be screened as compared with patients of health centers, hospital-based clinics, and staff model health maintenance organizations (68%, 86%, 89%, and 91% respectively). Variation in screening rates persisted in a multivariate analysis controlling for family sociodemographic characteristics and practice level variation. Of the 1587 children who had a documented blood lead test, 467 children (29%) had a blood lead level of >10 mg/dL on at least 1 test.Conclusions. Blood lead screening rates in Rhode Island's Medicaid managed care program are dramatically higher than national estimates for children who are enrolled in Medicaid. Potential explanations for this finding are 1) a high sensitization to the problem of lead poisoning in Rhode Island, 2) the primary care focus of the Medicaid program in Rhode Island facilitates the delivery of preventive services, and 3) the medical record audit approach used in this study was more comprehensive in identifying blood lead screens than techniques used in national studies. The high prevalence of elevated blood lead levels found in this study emphasizes the importance of screening among children who are enrolled in Medicaid. Pediatrics 2001;108(2). URL: http://www.pediatrics.org/cgi/content/full/108/2/e29; lead screening, Medicaid managed care.ABBREVIATIONS. NHANES, National Health and Nutrition Examination Survey; HMO, health maintenance organization; MCO, managed care organization; CI, confidence interval; OR, odds ratio.T he deleterious effects of lead poisoning on young children have been well documented. [1][2][3][4][5][6] Blood lead levels as low as 10 g have been associated with negative effects on a ...

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Section: Discussionmentioning

confidence: 99%

A Statewide Assessment of Lead Screening Histories of Preschool Children Enrolled in a Medicaid Managed Care Program

et al. 2001

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“…Previous research has demonstrated that assessments based on medical record reviews alone are biased by the inclusion of inactive patients and missing immunization histories. 37 Prompted by physician concern, we assisted participants to develop an alternative definition of their active patient population. For the third assessment round, the alternative criteria yielded rates that were 18 percentage points higher than those based on the CDC standard criteria.…”

Section: Limitations and Methodological Considerationsmentioning

confidence: 99%

Improving Immunization Rates in Private Pediatric Practices Through Physician Leadership

Sinn¹,

Morrow²,

Finch³

1999

Arch Pediatr Adolesc Med

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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.

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“…In addition, they found that supplemental information supplied by parents increased vaccination coverage estimates by 3.6% over those estimates based solely on medical records. The findings of Darden et al 29 are reassuring because they suggest that misclassification may be a relatively small problem. Nonetheless, we would be remiss in failing to mention the possibility of confounding by such misclassifications.…”

mentioning

confidence: 92%

“…Darden et al 29 attempted to quantify the impact of these misclassifications on their office-based study. They found that when parent contact information was used to exclude inactive patients, vaccination coverage estimates increased by 4.5%.…”

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confidence: 99%

Immunization Levels and Risk Factors for Low Immunization Coverage Among Private Practices

et al. 2000

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ABSTRACT.Objectives. Previous studies have indicated that provider characteristics are an important determinant of immunization coverage. The objectives of this study were to: 1) assess immunization coverage levels among 2-year-old children receiving care in private practices in 3 California counties; and 2) evaluate practice and patient risk factors for low immunization coverage.Study Design. Cross-sectional chart review of immunization histories and provider survey of immunization policies.Setting. Forty-five randomly selected, private medical practices in 3 counties in California.Patients. Children 12 to 35 months old, followed by the participating practices.Methods. Providers underwent a detailed assessment of their immunization coverage and completed a questionnaire describing their immunization policies and procedures. Immunization data were abstracted from randomly selected medical charts of children 12 to 35 months old. Only patients who met the criteria for active status (>2 visits and >1 visit during the preceding 18 months) were included in analyses. Immunization coverage levels were calculated and logistic regression was used to estimate the risk of underimmunization associated with different practice and child characteristics.Results. Of the 72 eligible practices that were contacted, 45 participated in the study, yielding a participation rate of 62%. The median immunization coverage of participating offices was 54% (range: 0%-91%). Multivariate analysis revealed 5 independent risk factors for underimmunization. The strongest predictors were having fewer than 50% active children in the practice and children having fewer than 8 visits to the provider. Other significant predictors were the percentage of patients in the practice on Medicaid, administering diphtheriatetanus-pertussis 4 at a separate visit from the Haemophilus influenzae type b booster, and practice location.Conclusions. These data provide new insights into immunization practices in an important clinical setting that has been poorly characterized previously. Immunization coverage levels were found to be low and significant risk factors for underimmunization were identified. Recommendations are made for immunization policy changes and targeting of immunization improvement interventions at practices that may be at risk for low immunization coverage. Pediatrics 2000; 105(6). URL: http://www.pediatrics.org/cgi/content/ full/105/6/e73;

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Methodological Issues in Determining Rates of Childhood Immunization in Office Practice

Cited by 31 publications

References 11 publications

A Statewide Assessment of Lead Screening Histories of Preschool Children Enrolled in a Medicaid Managed Care Program

A Statewide Assessment of Lead Screening Histories of Preschool Children Enrolled in a Medicaid Managed Care Program

Improving Immunization Rates in Private Pediatric Practices Through Physician Leadership

Immunization Levels and Risk Factors for Low Immunization Coverage Among Private Practices

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