Team-based approach improves childhood immunization rates

By Will Boggs MD

NEW YORK (Reuters Health) - A structured, team-based approach can improve childhood immunization rates in a hospital-based primary care practice, researchers say.

Almost a quarter of US young children are incompletely immunized, but Boston Children's Hospital fully immunized 85% of their patients by 2006 after implementing immunization improvement initiatives.

In an effort to increase that center's immunization rate further, Dr. Ronald C. Samuels and colleagues designed a new quality improvement initiative that incorporated systematic identification and capture of target patients, use of a patient-tracking registry, and patient outreach and care coordination.

Between January 2009 and December 2012, for 2,398 children aged 24 months, the mean overall immunization rate was 90%, but this reached 93% after excluding vaccine refusals and practice transfers, according to the March 24th Pediatrics online report.

Among 328 under-immunized patients, their efforts resulted in full immunization of 194 (59%). Twenty patients (6%) remained under-immunized despite care coordination and outreach attempts. Ninety-nine patients (30%) refused vaccines, transferred care, or were unreachable by phone or mail. Immunization records could not be recovered on the remaining 15 patients.

Fully immunizing the 194 patients required 504 total outreach attempts (mean, 2.6 per patient).

"Our findings corroborate previous research demonstrating higher immunization rates through tracking- and outreach-based interventions in pediatric primary care," the researchers conclude. "Our study also supports the effectiveness of multicomponent interventions for improving immunization coverage for socioeconomically disadvantaged populations."

"We are applying the patient-tracking registry and outreach components from the initiative to improve our adolescent immunization rates," they say. "Additional research is needed to clarify whether the initiative can be replicated across different patient and practice types."

Dr. Manika Suryadevara from the State University of New York Upstate Medical University in Syracuse told Reuters Health, "This quality improvement initiative to increase immunization rates in this age group would be feasible in our institution, which has a large, pediatric practice and electronic medical records to aid in the tracking of both the age groups and immunization status."

"Provider reminders, particularly through the use of electronic medical records, to ensure that vaccine status is being addressed at all visits (well and acute) may also be useful," Dr. Suryadevara said. "Medical access is another barrier to vaccine completeness in young children. Providing immunization clinics at sites where resource poor families access community services has also been shown to improve immunization rates in this population."

"Improving pediatric immunization rates is necessary to reduce vaccine preventable disease outbreaks," Dr. Suryadevara concluded. "Multicomponent interventions, which include immunization tracking and patient outreach, are successful in improving immunization coverage rates in resource poor children."

Dr. Samuels did not respond to a request for comments.

SOURCE: http://bit.ly/1rob07W

Pediatrics 2014;133:e1047-e1054.

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