Impact of resident feedback on immunization outcomes

Objective: To investigate the effect on immunization levels of retrospectiv e written feedback to residents regarding missed immunization opportunities . Design: Randomized trial with control group. Setting: Pediatric resident continuity clinic in an urban hospital-based pr imary care clinic. Participants: Thirty-two postgraduate level 2 and postgraduate level 3 pedi atric residents. Intervention: Monthly retrospective written feedback mailed to residents de tailing their missed immunization opportunities and appointment failure rat es over a 12-month period beginning in February 1997. Main Outcome Measures: The immunization level of 2-year-old children in the resident clinic was the main outcome of interest: Secondary outcomes inclu ded missed immunization opportunity rates and appointment failure rates. Results: Postintervention immunization levels were 71.4% (95% confidence li mits [CLs]:63.2%, 78.7%) for patients from the intervention group and 68.5% (95% CLs: 60.8%, 75.4%) for patients from the control group. The immunizat ion level for patients of both groups who had fewer than 2 visits during th e second year of life was 47.2% (95% CLs: 38.2%, 56.3%). This compares with an immunization level of 78.1% (95% CLs: 66.0%, 87.5%) for patients from b oth groups who had 2 visits during the second year of life, and with an imm unization level of 88.2% (95% CLs: 81.0%, 93.4%) for patients of both group s who had more than 2 visits during the second year of life (P<.001). Conclusions: In this setting, written retrospective feedback to residents w as an ineffective strategy for improving immunization levels. Adequate foll ow-up during the second year of life is critical in achieving high immuniza tion levels.