IMPACT OF MEASUREMENT AND FEEDBACK ON VACCINATION COVERAGE IN PUBLIC CLINICS, 1988-1994

Objective.-To investigate whether a reported rise in vaccination cover age in Georgia public clinics during the period 1988 through 1994 was artifactual or real and, if real, to determine the extent to which the rise could be associated with a program of measurement and feedback. Design.-Examination of data from Georgia public clinics, doses-adminis tered records, and National Health Interview Surveys. Setting/Particip ants.-Children attending Georgia public clinics. Intervention.-Measure ment of vaccination coverage and feedback to providers. Main Outcome M easure.-Vaccination coverage rates. Results.-For the period 1988 throu gh 1994, 136 004 Georgia public clinic vaccination records for childre n 21 to 23 months of age were reviewed. Median series-completion rates at public clinics rose from 53% to 89%, while indexes of under-vaccin ation fell: missed opportunities for simultaneous vaccination (6% to 0 %), lost contact for more than 12 months (14% to 1%), and first vaccin ation more than 1 month late (19% to 8%). According to the independent doses-administered database, the proportion of children starting the primary series very late (greater than or equal to 12 months old) fell from 14% to 6%, and the series-completion index rose from 64% to 83%, suggesting that improvements could not be wholly ascribed to better c linic record keeping. In 1988, vaccination coverage of children 24 mon ths of age in the National Health Interview Survey (NHIS) was 53%, ide ntical to median public clinic coverage in Georgia; in 1993, NHIS cove rage was 60%, while median public clinic coverage in Georgia was 90%, suggesting that the rise in coverage in Georgia public clinics exceede d national trends. Patterns within the coverage changes suggest an ass ociation with the process of measurement and feedback. Conclusions.-A marked increase in vaccination coverage occurred in Georgia public cli nics associated with a program of annual measurement and feedback.