Effectiveness of a practice-based intervention to increase vaccination rates and reduce missed opportunities

Background: Although provider feedback and recall/ reminder systems have be en shown to increase vaccination rates for children, little is known about the effectiveness of less intensive interventions. Objective: To determine whether provider prompting at acute care visits in an urban hospital-based outpatient clinic can increase vaccination rates an d decrease missed opportunities. Design and Methods: Study participants, 3 years or younger, were identified from a managed care organization as receiving primary care at the clinic. Eligibility criteria included 1 or more visits to the clinic without regard to continuity of enrollment. Patients' vaccination records were generated at nursing triage and attached to the encounter sheet. Vaccination and visi t data were abstracted from medical records, and comparisons were made betw een baseline (n=521) and postintervention (n=642) groups for up-to-date vac cination rates, missed opportunity rates, and mean numbers of visits. Results: Up-to-date rates at the age of 24 months for 4 diphtheria and teta nus toxoids and pertussis, 3 polio, 1 measles-mumps-rubella, 3 hepatitis B, and 3 Haemophilus influenzae type b vaccines changed from 70% to 78% (P=.0 7). Up-to-date rates increased significantly to 87% among the subset of chi ldren continuously enrolled in the managed care organization and the practi ce (P<.01). Overall, mean numbers of visits were similar. Missed opportunit y rates among children not up-to-date for 4 diphtheria and tetanus toxoids and pertussis, 3 polio, 1 measles-mumps-rubella, 3 hepatitis B, and 3 Haemo philus influenzae type b vaccines at the age of 24 months declined from 65% to 45% (P=.04). Similar trends were noted at rite age of 10 months. Conclusions: In the absence of increased funding, minor changes in standard operating procedures may improve vaccination delivery. Further improvement s may require efforts to ensure continuity of provider and plan assignment.