2009 Southern Regional Meeting Abstracts

Purpose of Study: Assessing the process of immunization administration in pediatric practices is necessary in order to identify ways to improve quality in the delivery of care. The purpose of this study is to evaluate pediatric practices’ ability to track their patients’ need for, and deliver immunizations. We will also validate their responses as part of a quality improvement initiative.
Methods Used: We surveyed pediatric practices about their current immunization procedures. The surveys consisted of 20 ‘yes/no’ questions and included categories of immunization assessment, medical record keeping, opportunities for immunization administration, and prompting of both providers and patients. Subsequently, we visited practices to directly observe their immunization delivery process and review their charts to validate survey answers.
Summary of Results: Two of the 6 participating practices reported that they assess immunizations rates annually and provided feedback to clinicians. All reported that they have a consistently available vaccine supply, that immunization records were available in 1 easy to locate place in the medical record, and that they immunize at sick visits. All providers reported they were prompted to give immunizations at well visits. Five reported sending reminders of upcoming visits (phone or mail). Three of the 6 practices reported having standing orders for routine immunizations. No practice has a recall system in place when children are overdue for immunizations. After initial on-site observation in the practices, only 1 practice in fact has a single place in the medical record where shots are recorded. Only 2 practices used some type of a prompt for immunizing at sick visits. Upon record review, the frequency of missed opportunities for providing immunizations at sick visits ranged from18%-64%.
Conclusions: Providers’ report of immunization delivery processes do not always agree with direct observation. When immunization delivery is suboptimal, verification of processes are necessary to identify opportunities for improvement. Clear and concise record keeping is necessary to improve immunization delivery.