Pg. Harper et al., A CLINIC SYSTEM TO IMPROVE PRESCHOOL VACCINATIONS IN A LOW SOCIOECONOMIC-STATUS POPULATION, Archives of pediatrics & adolescent medicine, 151(12), 1997, pp. 1220-1223
Objective: To determine if a clinic system to assess and vaccinate pre
school-age children at every clinic visit can improve vaccination rate
s. Design: A nonequivalent control group design contrasting an interve
ntion clinic with a comparison clinic. Setting: Two urban St Paul, Min
n, clinics. The intervention clinic is a family practice residency cli
nic, and the comparison clinic is a community health center clinic. Pa
tients: Primarily a low socioeconomic status white population. Interve
ntions: A clinic-wide system to identify and vaccinate children at all
clinic visits. Appointment personnel, medical assistants, and physici
ans all had roles in the intervention protocol. Main Outcome Measures:
Percentage of children at the 2 clinics who were up-to-date for a pri
mary vaccine series at age 24 months and also at the end of the study
collection periods, preintervention and postintervention. Results: The
intervention clinic improved the percentage of children up-to-date fo
r a primary vaccine series at age 24 months from 42% to 56% (P=.02), w
hile the percentage at the comparison clinic did not change significan
tly (P=.81). Similarly, the intervention clinic improved the percentag
e of children up-to-date for age at the end of the study periods from
49%, preintervention to 63% postintervention (P=.02), while the percen
tage at the comparison clinic did not improve significantly (P=.45). T
he system was especially useful for children with few visits to the in
tervention clinic. Conclusions: Although the intervention clinic resul
ted in a substantial improvement in vaccination rates for preschool-ag
e children, rates remained well below national goals. A combination of
clinic, community, and national initiatives may be needed to ensure a
ppropriate vaccination rates for this challenging patient population.