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Immunization status among children newly enrolled in a health plan: a new frontier for quality measurement?
Tracy A Lieu1, Mehran R Massoudi, Irina L Miroshnik
1Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, and Harvard Medical School, Boston, Mass 02215, USA. tracy_lieu@hphc.org
Insights
Children enrolling later in health plans (12-17 months) show lower immunization rates by age 24 months. However, catch-up vaccination schedules can effectively immunize most of these children.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- The National Scientific Panel on Immunization Measurement Standards recommends expanding the assessment population for childhood immunization quality measures.
- The proposed change includes 24-month-olds with at least 6 months of continuous health plan enrollment, a reduction from the current 12-month criterion.
- This adjustment aims to include children with more recent enrollment histories in quality assessments.
Purpose of the Study:
- To compare the immunization status of children enrolled in a large health plan between 12-17 months of age versus those enrolled earlier.
- To determine the proportion of children enrolled between 12-17 months who could achieve full immunization by 24 months of age.
Main Methods:
- A retrospective cohort study identified children in a group-model Health Maintenance Organization (HMO) who reached 24 months of age.
- Immunization data were extracted from a computerized database, with medical record review for discrepancies.
- Children were categorized based on enrollment age: birth to 11 months vs. 12 to 17 months.
Main Results:
- Of 3448 children, 91% enrolled by 11 months and 5% enrolled between 12-17 months.
- Fully immunized by 24 months: 87% of early enrollees vs. 57% of late enrollees (risk difference: 30%).
- Among late enrollees, 68% had primary series vaccines; 94% could be fully immunized by 24 months with catch-up schedules.
Conclusions:
- Children enrolling between 12-17 months have lower full immunization rates by 24 months compared to earlier enrollees.
- Accelerated vaccination schedules are feasible for nearly all late-enrolling children to achieve full immunization by 24 months.
- Including these children in immunization quality measures, as a separate group or combined, broadens the evaluation of healthcare quality.
Background:
The National Scientific Panel on Immunization Measurement Standards recently recommended that the assessment population for the childhood immunization measure of the Health Plan Employer Data and Information Set include 24-month-olds with > or = 6 months of continuous enrollment in a health plan. The current inclusion criterion is > or = 12 months of continuous enrollment. The new recommendation would expand the assessment population to include children with more recent enrollment.
Objectives:
To compare the immunization status of children enrolled in a large health plan between ages 12 and 17 months vs earlier in life and to describe the proportion of children enrolled between ages 12 and 17 months that could be fully immunized by 24 months.
Methods:
All children enrolled in a group-model HMO who turned 24 months old during a 12-month study were identified for a retrospective cohort study. A computerized immunization database was used to identify all vaccines administered to each child, and summary measures were created to describe immunization status at selected times. The full-text medical records of children who seemed to have no immunizations in the computerized database were reviewed.
Results:
Of the 3448 children in the study population, 3130 (91%) enrolled between birth and 11 months of age and 161 (5%) enrolled between 12 and 17 months of age. Whereas 87% of children who enrolled between birth and 11 months of age were fully immunized at age 24 months, only 57% of those enrolled between 12 and 17 months of age were fully immunized at 24 months of age (risk difference, 30%; 95% confidence interval, 24%-36%; P < .001). Of the 161 children enrolled between 12 and 17 months of age, 68% had received all of the immunizations in the primary series. Only 6% of these 161 children would have been impossible or difficult to fully immunize by age 24 months using accelerated catch-up vaccination schedules.
Conclusions:
Children who enrolled in an HMO between 12 and 17 months of age were less likely than those who enrolled earlier in life to be fully immunized by age 24 months, but it would be feasible to bring almost all of them up to date by that age. Including such children in immunization measures, either together with earlier-enrolled children or as a separate stratum, would expand the scope of the quality of care under evaluation.
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