Ms. Massoudi et al., Assessing immunization performance of private practitioners in Maine: Impact of the Assessment, Feedback, Incentives, and Exchange strategy, PEDIATRICS, 103(6), 1999, pp. 1218-1223
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.