Improving immunization rates in private pediatric practices through physician leadership

Objective: To determine whether a physician-led quality improvement initiat ive can improve immunization rates in participating private practices. Design: Surveys of private pediatric practices at 6-month intervals over an 18-month period. Setting: Ten private pediatric practices in Norfolk and Virginia Beach, Va. Patients: Children aged 9 to 30 months attending the private practices. Interventions: Practice immunization rates were assessed and presented to p ractices on 4 occasions at 6-month intervals. A physician leader convened a n immunization task force meeting following the first 3 assessments to revi ew practice guidelines, examine data, and discuss practice changes. Main Outcome Measures: Practice immunization rates for patients at age 24 m onths, with 3- and 12-month immunization rates as secondary outcomes. Results: The mean practice immunization rate at age 24 months increased sig nificantly (P<.05) from 50.9% at baseline to 69.7%. Rates also increased at age 3 months, from 75.5% to 88.9%, and at age 12 months, from 72.9% to 84. 6%. The median age at administration of the fourth dose of diphtheria toroi d, tetanus toroid, and pertussis vaccine decreased (P<.05) from 17.6 to 16. 8 months. Physicians also reported making additional changes, including imp roved record keeping and screening for immunizations at every visit. Conclusion: A quality improvement initiative enabling physician leadership can improve preschool immunization practices and coverage levels in pediatr ic practices.