A preschool immunization project to enhance immunization levels, the public-private relationship, and continuity of care

This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunization s to preschool-aged children would help to improve immunization rates and r educe fragmented care for patients. Twenty physicians from 14 private pract ices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly s elected subset of patient case records from the physicians' offices were au dited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. T hese 310 records of children under three years of age who were treated betw een 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender; however, significantly more families in the 1988 through 1 990 cohort of children under 3 years of age were insured privately when com pared to the 1991 through 1994 cohort Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compare d to 45% (141) of the baseline records, reflecting a statistically signific ant difference (p<.00001). The intervention sample showed significantly mor e well child visits where immunizations were given and follow up visits whe re immunizations were given when compared to the baseline sample. Physician s completed surveys before and after implementation of the project. They we re questioned about their knowledge and practices regarding immunizations a s well as their opinion of specific project components. All of the physicia ns viewed the project as an effective means to improve immunization service s to low income children. The project demonstrates a potential means of enh ancing immunization levels and continuity of care among preschool-aged chil dren. It also highlights the workable nature of the partnership between pub lic and private sectors.