1. Immunization Assessments: More Than a Single Visit
NYC Department of Health Immunization Program

2. Assessments: More Than A Single Visit
Karin Seastone Stern, DrPH,Director Clinic Assessments
Denise Benkel, MD, MPH, Medical Specialist, Child Health Initiative
Stephen Friedman, MD MPH, Assistant Commissioner
Paula Francis-Crick, IAP Assessment Team Member
Frank Roldan, CDC, Program Operations Director
For more information contact

3. NYC 5 Boroughs 722 miles of subway 108,000 2-Year Olds
1,200 VFC Private Providers
70 Public Hospitals & Child Health Clinics
2001 Assessments:
Represented 12,000
11% of 2 Yr Old Population
4,000 Chart Reviews

4. Assessment Feedback Report Feedback Meeting Process
Chart Review – Paper Tool and Computer Entry
2nd birthday date of assessment
4:3:1:3:3 and varicella
Feedback Report
Identify Barriers including MOV, Chart Organization
Recommendations
List Under-Immunized Children
Feedback Meeting

5. Utilize the assessment
Follow-up Actions
Utilize the assessment
Listed under-immunized children
DOH promised to return in 2-3 months to reassess charts
Actively involve the provider
Provider needs to re-review incomplete charts
Provider recalls / deactivates charts / utilizes the registry
Provider initiates changes in the practice
Incentive
Re-calculate coverage rates for the cohort
Incorporate changes into the practice

6. List of Under-Immunized Children to Recall

7. Outcome: Increased coverage after recall 11 weeks after assessment
18-35 month olds (N=19 providers)

8. 4:3:1:3:3 Series coverage at assessment and after recall
18 – 35 months of age, 19 sites, 2001

11. Reasons associated with missed opportunity to vaccinate
43 Public Clinics and Private Providers, 2001 (n=748)

12. Barrier: Accepting and Giving Excuses Intervention
Turn the excuse into an explanation

13. “But, the complications are NOT mild.”
“Chickenpox is a mild disease.”
“But, the complications
are NOT mild.”
Protect the other family members.
If parent refuses, document chart.

14. Approaches to overcoming provider as barrier
Here’s a copy of our paper tool,
please correct it if we are wrong.
Here’s a copy of the immunization schedule,
let’s review what is not clear.
Pretend we’re your consultant.

15. Passive process Active process Adversary Advocate
ASSESSMENT: More than a single visit
Passive process Active process
Adversary Advocate
For this cohort, significant improvement in coverage
Initiate clinical & administrative changes
Establish precedent for continued improvement

16. Assessment Team Members IAP
Cheryl Bodden
Paula Francis Crick
Timothy Salters
VFC
Cassandra Deas Daryl Perry
Polly Hobbs Vasu Nalipireddy