The Effect of Education, Feedback, and Provider Prompts on the Rate of Missed Vaccine Opportunities in a Community Health Center

Abstract

The purpose of this study was to determine whether education, feedback, and provider prompts decrease the rate of missed vaccine opportunities; and the reasons for missed opportunities in the post-intervention group. A nonrandomized, before and after study to evaluate the effect of education, feedback, and provider prompts on missed opportunities was conducted in an inner-city community health center with a predominantly hispanic population. Vaccine opportunities were defined as visits of children 36 months or younger who were vaccination-eligible by ACIP guidelines. Consecutive sampling was used to identify two groups of children with vaccine opportunities: pre- and post-intervention. Feedback was given to vaccine providers on the frequency of missed opportunities in the pre-intervention group. The ACIP recommended vaccine schedule and true vaccine contraindications were reviewed. Nursing personnel were taught to identify and tag charts of children with vaccine opportunities. Physicians were asked to record vaccination status and the reason any vaccination was deferred. Missed opportunities decreased significantly, from 49% (173/352) to 13% (45/344), after the interventions (p < 0.001). The reasons for the 45 missed opportunities in the post-intervention sample were parent refusal (15.6%), moderate or severe illness (15.6%), and incorrect documentation as "up-to-date" (13.3%). In 28.9% there was a missed opportunity for simultaneous immunization. No reasons were documented for the remaining missed opportunity visits (26.6%). The interventions, which emphasized improving provider knowledge of vaccinations and screening vaccine status at each visit, effectively decreased missed opportunities.

A randomized trial of maternal influenza immunization decision-making: A test of persuasive messaging models

“…46,47 These findings are mirrored in other studies that have examined challenges with vaccine uptake among racially and ethnically diverse minority communities. 48,49 Our findings reinforce the notion that maternal immunization is not likely to shift without effective, repeated messaging that normalizes vaccination as a women's and infant health protection issue. 50 With 80% of our sample expressing that they consider their OB/GYN to be their primary care physician, yet only 5% of them ever having received a vaccine from their OB/GYN, there is a unique opportunity presented to shift the targeted technologically driven messages delivered by our intervention toward more tailored practice-based messaging strategies in the future.…”

Delivering Adolescent Vaccinations in the Medical Home: A New Era?

“…Missed opportunities for vaccinations 55,56 (health care visits at which a patient is eligible to receive a vaccination but does not receive one) are particularly important, because adolescents have fewer visits than do younger children. In addition, some providers still recommend biennial preventive visits for adolescents, although most current guidelines recommend annual preventive visits.…”

“…57 Although rigorous studies have noted only limited success with interventions to eliminate missed opportunities in children 55,56 and adults, 58 interventions to reduce missed opportunities may still be more feasible than other strategies that require more resources.…”

“…Tracking, reminders, and recall are almost certain to be needed to achieve high adolescent vaccination rates 56,60 except in those populations in which adolescents already have high rates of health care visits.…”

Increasing Inner-City Adult Influenza Vaccination Rates: A Randomized Controlled Trial

“…These strategies included increasing community demand for vaccinations, enhancing access to vaccination services, and implementing provider-or system-based interventions, 21 such as patient reminder/recall and health-care provider prompts about vaccinations. [22][23][24][25] The Task Force recommended combination strategies, including interventions from more than one of the aforementioned categories. Most studies of immunization strategies have used single interventions and applied the interventions in single practices rather than across a community or network of practices.…”