printed by Missed Opportunities to Immunize: Systematic Changes To Boost Immunization Rates Rob Hays, MD, Tim Barker, MD, and Sally P. Weaver, PhD, MD McLennan County Medical Education and Research Foundation Family Residency Program, Waco, Texas McLennan County Medical Education and Research Foundation Family Medicine Residency Program, Waco, Texas BACKGROUND METHODS RESULTS   Over 20 percent of Texas children are missing at least one dose of recommended vaccines.   The National Immunization Survey is taken by the Centers for Disease Control and Prevention.   The survey measures the levels of vaccinations for children aged 18 through 35 months. Immunization rates are based on completing all of the following immunizations: 4 or more doses of DTaP, 3 or more doses of poliovirus, 1 or more doses of MMR, 3 or more doses of Hib3, 3 or more doses of HepB, 1 or more doses of varicella. Nurses were given responsibility for ordering any immunizations that were due at all visit types for children ages months old (N~350/mth). Daily reports were generated using the EHR: - Missed opportunities for vaccination report - Incomplete immunization documentation report Feedback was provided to individual nurses by the Director of Nursing based on the daily reports. Recall letters were sent to children who were due for or behind on vaccinations. REFERENCES 1. Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Recent trends in teenage pregnancy in the United States, Health E-stats. Hyattsville, MD: National Center for Health Statistics. Released December 13, U.S. Department of Health and Human Services, Health Resources and Services Administration. Women’s Health USA Rockville, Maryland: U.S. Department of Health and Human Services, US, National Immunization Survey, 3/2006-2/ Accessed-5/6/ “Immunization Information System Progress --- United States, 2003.” MMMR Weekly July 29, 2005 / 54(29); Accessed 5/6/ “Report on Plans to Increase Immunization Rates in Texas.” Disease Prevention and Intervention Section, Texas Department of State Health Services, September 30, DISCUSSION February started program. Feedback to nurses lapsed in Nov. Red line = TX average Green line = National average By implementing a systems-based approach, we were able to improve our clinic vaccination rate by about 10% in one year. The EHR made it easy to track immunization records, review reports, and send out letters to those patients who were due for or behind on their vaccinations. Theoretically, our vaccination rates could have been improved even more given the fact that our clinic has a fairly high number of floating nurses who were not familiar with the vaccination protocol, and vaccinations not given due to contraindications were not recorded. Other methods proposed by the Texas Health and Human Services Department to improve vaccination rates include: Promoting the Medical Home Promoting the Use of ImmTrac, statewide vaccine registry Promoting the Use of Reminder and Recall Systems Expanding Provider Education Increasing Public/Parent Education Developing Public/Private Partnerships Internal review indicated that we were missing opportunities to catch up on vaccinations on non-health maintenance related visits. But, we have an electronic health record (EHR) that has the capability to track immunizations! The Healthy People 2010 goal for child immunization rates is 90% of above stated immunizations. Texas Current Immunization Rate % US Current Immunization Rate % PROBLEM