Assessing immunization performance of private practitioners in Maine: Impact of the Assessment, Feedback, Incentives, and Exchange strategy

Introduction. A provider-based vaccination strategy that has strong support ive evidence of efficacy at raising immunization coverage level is known as Assessment, Feedback, Incentives, and Exchange. The Maine Immunization Pro gram, and the Maine Chapter of the American Academy of Pediatrics collabora ted on the implementation and evaluation of this strategy among private pro viders. Methods. Between November 1994 and June 1996, the Maine Immunization Progra m conducted baseline immunization assessments of all private practices admi nistering childhood vaccines to children 24 to 35 months of age. Coverage l evel assessments were conducted using the Clinic Assessment Software Applic ation. Follow-up assessments were among the largest practices, delivering 8 0% of all vaccines. Results. Of the 231 practices, 58 were pediatric and 149 were family practi ces. The median up-to-date vaccination coverages among all providers for 3 doses of diphtheria-tetanus-pertussis vaccine and 2 doses of oral polio vac cine, and 4 doses of diphtheria-tetanuspertussis vaccine, 3 doses of oral p olio vaccine, and 1 dose of measles-mumps-rubella vaccine at age 12 and 24 months were 90% and 78%, respectively, and did not vary by number of provid ers in a practice or by specialty. Urban practices had higher coverage than rural practices at 12 months (92% vs 88%). The median up-to-date coverage for 4 doses of diphtheria-tetanuspertussis vaccine, 3 doses of oral polio v accine, and 1 dose of measles-mumps-rubella vaccine at 24 months of age imp roved significantly among those practices assessed 1 year later (from 78% a t baseline to 87% at the second assessment). On average, the assessments re quired 21/2 person-days of effort. Conclusions. We document the feasibility and impact of a public/private par tnership to improve immunization delivery on a statewide basis. Implications. Other states should consider using public/private partnership s to conduct private practice assessments. More cost-effective methods of a ssessing immunization coverage levels in private practices are needed.