EFFECT OF 2 URBAN EMERGENCY DEPARTMENT IMMUNIZATION PROGRAMS ON CHILDHOOD IMMUNIZATION RATES

Background: Emergency departments (EDs) are recommended as sites for i mmunizing children. However, there is little information about the eff ect of ED immunization programs on immunization rates. Objectives: To assess the ability of 2 ED immunization programs to vaccinate children and to measure the effect of the programs on immunization rates after the ED visit and 6 months later. Design: A prospective cohort study. Emergency department patients were screened for immunization status, a nd vaccinations were offered to patients who either were documented to be eligible or were eligible by age and had no documented records. A systematic, sequential sample of those accepting vaccinations (study p atients) was compared with a systematic, sequential sample of those no t vaccinated (control subjects). Telephone interviews and medical reco rd reviews were performed 6 months after the ED visit to verify dates of immunizations. Results were weighted to reflect the sampling frames of patients screened by the 2 programs. Setting: Two EDs in New York City (in Manhattan and the Bronx) and the surrounding primary care off ices. Patients: Children (aged 0-6 years) screened for immunization st atus by the ED immunization program during a 10-week period; these inc luded 210 children from the Manhattan ED (106 vaccinated in the ED) an d 274 children from the Bronx ED (129 vaccinated in the ED). Intervent ion: Emergency department immunizations. Main Outcome Measures: Propor tion of patients (vaccinated, not vaccinated, and ED population) up-to -date for immunizations (1) at the time of the ED visit, (2) 1 day lat er, and (3) 6 months later. Results: Two thirds of the patients in eac h ED had Medicaid, and one tenth were uninsured. At the time of the ED visit, 20% of the vaccinated children in each ED were actually up-to- date and were unnecessarily vaccinated; 74% (Manhattan ED) and 72% (Br onx ED) of the not vaccinated children were up-to-date (the remainder were later determined to have been eligible for vaccinations). One day after the ED visit, and 6 months later, the immunization rates of the vaccinated and not vaccinated children were similar. The results of t he weighted analysis were as follows: for the entire ED population scr eened for immunization status, compared with up-to-date rates at the t ime of the ED visit, rates 1 day later were 11% (Manhattan ED) and 8% (Bronx ED) higher in each ED (P < .05;); and rates 6 months later were the same in the Manhattan ED and 10% lower in the Bronx ED (P < .01). Eighteen percent of all children screened for immunization status wer e vaccinated; 10 to 15 children were screened and 2 to 4 children were vaccinated per 8-hour ED shift. Conclusions: This ED immunization pro gram temporarily improved the immunization rates of the FD population, but substantial personnel time was required to achieve these small ga ins. Urban ED immunization programs are unlikely to be cost-effective.