1. Improving Pediatric Immunization Rates In Children Under the Age of 3 in Two University Community Clinics Chad Alan Spain, MD Kyle Bradford Jones, MD University of Utah Department of Family and Preventive Medicine
Introduction
Methods
Results
Discussion
OBJECTIVE
Achieve the Healthy People 2020 goal of 90% immunization rate for each vaccine and 80% combined immunization rates in children under 3 years of age by:
Decreasing missed opportunities
Providing outreach to patients not in clinic
DESIGN
A continuous quality improvement (CQI) project using Plan-Do-Study-Act (PDSA), team-based methodology
INCLUSION
Patients 0-35 months of age seen within the last 12 months at Madsen or Sugarhouse clinics
CLINICAL PROCESS
Immunization records were printed daily for scheduled pediatric patients from the Utah Statewide Immunization Information System (USIIS) and distributed to providers *While already occurring at MHC, this process was new to SHC
Clinic wide immunization reports were generated for patient outreach intervention
INTERVENTION
A letter was sent to each newly identified deficient patient informing of overdue immunization
After 6 weeks, a phone call was made to each deficient patient who had not yet come in for immunization
MHC
After filtering for those who were truly deficient and were still a member of clinic 40 patients received a letter
21 of these patients eventually needed and received a phone call
SHC
After filtering for those who were truly deficient and were still a member of clinic 55 patients received a letter
33 of these patients eventually needed and received a phone call
BACKGROUND
Goal of Healthy People 2020 is to obtain 90% immunization rate for each vaccine and 80% combined immunization rates in children under 3 years of age (4:3:1:3:3:1 [4DTaP, 3Polio, 1MMR, 3HIB, 3HepB, 1Var] series)
Nationally 44% of children aged 19 to 35 months in 2009 received the recommended doses of DTaP, polio, MMR, Hib, Hepatitis B, Varicella, and PCV
Each annual birth cohort vaccinated with the routine immunization schedule will ultimately:
Save 33,000 lives
Prevent 14 million cases of disease
Reduce direct health care costs by $9.9 billion
Save $33.4 billion in indirect costs
Madsen Family Health Center (MHC) immunized only 66% (n=188) of children under 3 years old as of November 2012 (4:3:1:3:3:1:3 series, this includes PCV )
Sugarhouse Family Health Center (SHC) immunized only 58% (n=319) of children under 3 years old as of November 2012
In a CQI project at MHC improved immunization rates in children under 2 years from 66% to 92% (n=91) via printing and distribution of daily immunization records of all children scheduled that day
Printing of daily immunization records with distribution to providers provides a sustainable method to improve immunization rates without alteration of work flow
Intervention allowed identification and targeting of deficient patients. Our intervention contributed to 20+% increased in combined immunization rates in both clinics
LIMITATIONS
Identification of patients who were no longer associated with the clinic came only after phone calls were made, potentially altering our overall ‘n’
USIIS is not currently integrated with our EMR. If immunizations were performed outside our clinics or were not entered into the database our data could be inappropriately low
Sustainability of outreach intervention would require additional staff hours
Significant improvement of pediatric immunization rates was accomplished with printing of daily immunization records for scheduled patients and intervention involving outreach to deficient patients
Presentation of this study was supported (in part) by the Dr. George D. Gross and Dr. Esther S. Gross Educational Endowment Fund in Family Medicine, Department of Family & Preventive Medicine, Division of Family Medicine, University of Utah.
MHC and SHC CQI Team: Jen Aoki (MA), Kay Haley (RN), Crystal Jones (MA), Luis, Linan (MA), Perlita Mendoza (MA), Mathew Percy (MD PGY-2)
Advisor: Susan Pohl MD
Printing of
Conclusions
Conclusions
Acknowledgements
Acknowledgements
Dr. George D. Gross and Dr. Esther S. Gross Endowment Fund in Family Medicine, Department of Family and Preventive Medicine, Division of Family Medicine, University of Utah.