Effectiveness of pediatric practice consultation on missed opportunities for immunization

Nancy Hughart, Elizabeth Holt, Jorge Rosenthal, Alan Ross, Alison Jones, Virginia Keane, Patrick Vivier, Bernard Guyer

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective. To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines. Design. The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed. Results. The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education- only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions. Conclusions. There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities.

Original languageEnglish (US)
Pages (from-to)123-134
Number of pages12
JournalJournal of Urban Health
Issue number1
StatePublished - Mar 1998
Externally publishedYes


  • Children
  • Immunization
  • Missed opportunities
  • Primary care
  • Tracking system
  • Vaccination

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health


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