Related Experiment Videos
Effectiveness of pediatric practice consultation on missed opportunities for immunization
N Hughart1, E Holt, J Rosenthal
1Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA. nhughart@jhsph.edu
Insights
Pediatric practice consultation did not significantly reduce missed vaccination opportunities. Improved tracking systems and vaccinating children during sick visits may be more effective strategies for increasing immunization rates.
Area of Science:
- Pediatric healthcare quality improvement
- Vaccination policy and practice
Background:
- Missed opportunities for childhood vaccinations are a significant public health concern.
- Achieving target immunization rates requires effective strategies within pediatric practices.
Purpose of the Study:
- To assess if pediatric practice consultation reduces missed opportunities for diphtheria and tetanus toxoids and pertussis vaccines.
- To compare an educational program alone versus an educational program with consultation.
Main Methods:
- Eight pediatric sites in Baltimore, Maryland, participated.
- Four sites received an educational program; four received the program plus consultation.
- Medical records were audited to determine missed-opportunity rates before and after interventions.
Main Results:
- The education-consultation group showed a 14% net reduction in missed opportunities, but this was not statistically significant.
- Education-only sites had a 10% increase, while education-consultation sites had a 4% decrease in missed opportunities.
- Two health maintenance organizations (HMOs) that reduced missed opportunities implemented new tracking systems.
Conclusions:
- Neither the educational program alone nor the combination approach demonstrated a significant reduction in missed vaccination opportunities.
- Enhanced tracking and follow-up systems appear crucial for reducing missed opportunities.
- Utilizing sick visits for vaccinations is suggested as a potential strategy to improve immunization coverage.
Objective:
To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines.
Design:
The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed.
Results:
The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education-only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions.
Conclusions:
There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities.