The status of immunization measurement and feedback in the United States

Background: A large body of scientific and programmatic data has demonstrat ed that provider measurement and feedback raises immunization coverage. Sta rting in 1995, Congress required that all states measure childhood immuniza tion coverage in all public clinics, and federal grant guidelines encourage private practice measurements. Objectives: To determine state immunization measurement rates and examine r isk factors for high rates. Methods: Review of 1997 state reports, with correlation of measurement rate s to birth cohort and provider numbers, public/private proportions, and vac cine distribution systems. Results: Of the 9505 public clinics, 45% were measured; + states measured a ll clinics; 29 measured a minority. Measurement rates were highest for Heal th Department clinics (67%), lower for community/migrant health centers (39 %), and lowest for other clinics (22%). Rates were highly correlated among categories of clinics (r>+0.308, P<.03), and the fewer the clinics, the hig her the measurement rates (r = -0.351, P =.01), but other factors were not significant. Of the 41 378 private practices, 6% were measured; no state me asured all its practices; 1 measured a majority. Private practice measureme nt rates were not correlated to public clinic measurement rates or other fa ctors examined. Of the 50883 total providers, 14% were measured; no state m easured all providers; 2 measured a majority. A trend toward higher measure ment rates was found in states with fewer providers (r=-0.266, P=.06). Conclusions: Three years after the congressional mandate, only a minority o f public clinics and very few private practices had their immunization cove rage measured. Greater efforts will be needed to assure implementation of t he intervention.