A CLINIC SYSTEM TO IMPROVE PRESCHOOL VACCINATIONS IN A LOW SOCIOECONOMIC-STATUS POPULATION

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.