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

Background: Although provider feedback and recall/reminder systems have been 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 and 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 visit data were abstracted from medical records, and comparisons were made between baseline (n=521) and postintervention (n=642) groups for up-to-date vaccination rates, missed opportunity rates, and mean numbers of visits. Results: Up-to-date rates at the age of 24 months for 4 diphtheria and tetanus 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=.07). Up-to-date rates increased significantly to 87% among the subset of children continuously enrolled in the managed care organization and the practice (P<.01). Overall, mean numbers of visits were similar. Missed opportunity 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 Haemophilus influenzae type b vaccines at the age of 24 months declined from 65% to 45% (P=.04). Similar trends were noted at the age of 10 months. Conclusions: In the absence of increased funding, minor changes in standard operating procedures may improve vaccination delivery. Further improvements may require efforts to ensure continuity of provider and plan assignment.