Changes in clinic vaccination coverage after institution of measurement and feedback in 4 states and 2 cities

Background: Since 1995, states and jurisdictions receiving federal immuniza tion funds have been required to perform annual measurements of vaccination coverage in their public clinics, based on data from Georgia where clinic coverage increased after the institution of a measurement and feedback inte rvention. Objective: To determine if clinic vaccination coverage improved in localiti es that used the Georgia intervention model. Design: Retrospective examination of clinic vaccination coverage data. Participants: Children aged 19 to 35 months enrolled in clinics in localiti es that had applied the intervention for 4 years or longer. Intervention: The Georgia intervention model: assessment of clinic vaccinat ion coverage, feedback of the information to the clinic, incentives to clin ics, and promotion of exchange of information among clinics (AFIX). Main Outcome Measure: Change in median clinic coverage rates, based on the primary (4-3-1) vaccine series, with comparison to results of the National Immunization Survey. Results: Four states and 2 cities that had applied the AFIX intervention fo r 4 years or longer were identified. The number of clinic records reviewed annually was 4639 to 18 000 in 73 to 116 clinics for states, and 714 to 527 6 in 8 to 25 clinics for cities. Median clinic coverage rose in all localit ies: Missouri, 44% (1992) to 93% (1997); Louisiana, 61% (1992) to 83% (1997 ); Colorado, 55% (1993) to 75% (1997); Iowa, 71% (1994) to 89% (1997); Bost on, Mass, 41% (1994) to 79% (1997); and Houston, Tex, 28% (1994) to 84% (19 97). The increase in clinic coverage exceeded that of the general populatio n in 5 localities and was identical in the sixth. The average annual, cover age rise attributable to the intervention was +5 percentage points per year (Georgia, +6 per year). The average crude direct program cost was $49 533 per locality per year. Conclusion: The Georgia intervention model (AFIX) can be reproduced elsewhe re and is associated with improvements in clinic vaccination coverage.