Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994

C. W. LeBaron, M. Chaney, A. L. Baughman, E. F. Dini, E. Maes, V. Dietz and R. Bernier
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

OBJECTIVE: To investigate whether a reported rise in vaccination coverage in Georgia public clinics during the period 1988 through 1994 was artifactual or real and, if real, to determine the extent to which the rise could be associated with a program of measurement and feedback. DESIGN: Examination of data from Georgia public clinics, doses-administered records, and National Health Interview Surveys. SETTING/PARTICIPANTS: Children attending Georgia public clinics. INTERVENTION: Measurement of vaccination coverage and feedback to providers. MAIN OUTCOME MEASURE: Vaccination coverage rates. RESULTS: For the period 1988 through 1994, 136 004 Georgia public clinic vaccination records for children 21 to 23 months of age were reviewed. Median series-completion rates at public clinics rose from 53% to 89%, while indexes of under-vaccination fell: missed opportunities for simultaneous vaccination (6% to 0%), lost contact for more than 12 months (14% to 1%), and first vaccination more than 1 month late (19% to 8%). According to the independent doses-administered database, the proportion of children starting the primary series very late (> or =12 months old) fell from 14% to 6%, and the series-completion index rose from 64% to 83%, suggesting that improvements could not be wholly ascribed to better clinic record keeping. In 1988, vaccination coverage of children 24 months of age in the National Health Interview Survey (NHIS) was 53%, identical to median public clinic coverage in Georgia; in 1993, NHIS coverage was 60%, while median public clinic coverage in Georgia was 90%, suggesting that the rise in coverage in Georgia public clinics exceeded national trends. Patterns within the coverage changes suggest an association with the process of measurement and feedback. CONCLUSIONS: A marked increase in vaccination coverage occurred in Georgia public clinics associated with a program of annual measurement and feedback.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effects of Continuity of Care in Infancy on Receipt of Lead, Anemia, and Tuberculosis Screening
Flores et al.
Pediatrics 2008;121:e399-e406.
ABSTRACT | FULL TEXT  

Vaccination rates in a multicultural population
van der Wal et al.
Arch. Dis. Child. 2005;90:36-40.
ABSTRACT | FULL TEXT  

The Impact of Reminder-Recall Interventions on Low Vaccination Coverage in an Inner-City Population
LeBaron et al.
Arch Pediatr Adolesc Med 2004;158:255-261.
ABSTRACT | FULL TEXT  

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population: A Cluster Randomized Controlled Trial
Hambidge et al.
Arch Pediatr Adolesc Med 2004;158:162-169.
ABSTRACT | FULL TEXT  

Adoption of Reminder and Recall Messages for Immunizations by Pediatricians and Public Health Clinics
Tierney et al.
Pediatrics 2003;112:1076-1082.
ABSTRACT | FULL TEXT  

Increasing Immunization Coverage
Committee on Community Health Services and Committ
Pediatrics 2003;112:993-996.
ABSTRACT | FULL TEXT  

The Effect of Education, Feedback, and Provider Prompts on the Rate of Missed Vaccine Opportunities in a Community Health Center
Sabnis et al.
CLIN PEDIATR 2003;42:147-151.
ABSTRACT  

A Computerized Reminder System to Increase the Use of Preventive Care for Hospitalized Patients
Dexter et al.
NEJM 2001;345:965-970.
ABSTRACT | FULL TEXT  

Effectiveness of a Practice-Based Intervention to Increase Vaccination Rates and Reduce Missed Opportunities
Minkovitz et al.
Arch Pediatr Adolesc Med 2001;155:382-386.
ABSTRACT | FULL TEXT  

The Status of Immunization Measurement and Feedback in the United States
LeBaron et al.
Arch Pediatr Adolesc Med 2000;154:832-836.
ABSTRACT | FULL TEXT  

Performance Measurement Through Audit, Feedback, and Profiling as Tools for Improving Clinical Care
Weiss and Wagner
Chest 2000;118:53S-58S.
ABSTRACT | FULL TEXT  

Effect of Method of Defining the Active Patient Population on Measured Immunization Rates in Predominantly Medicaid and Non-Medicaid Practices
Morrow et al.
Pediatrics 2000;106:171-176.
ABSTRACT | FULL TEXT  

Vaccination Practices, Policies, and Management Factors Associated With High Vaccination Coverage Levels in Georgia Public Clinics
Dietz et al.
Arch Pediatr Adolesc Med 2000;154:184-189.
ABSTRACT | FULL TEXT  

How Much Time Is Spent on Well-Child Care and Vaccinations?
LeBaron et al.
Arch Pediatr Adolesc Med 1999;153:1154-1159.
ABSTRACT | FULL TEXT  

Impact of Resident Feedback on Immunization Outcomes
Rust et al.
Arch Pediatr Adolesc Med 1999;153:1165-1169.
ABSTRACT | FULL TEXT  

The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care
Hillman et al.
Pediatrics 1999;104:931-935.
ABSTRACT | FULL TEXT  

Changes in Clinic Vaccination Coverage After Institution of Measurement and Feedback in 4 States and 2 Cities
LeBaron et al.
Arch Pediatr Adolesc Med 1999;153:879-886.
ABSTRACT | FULL TEXT  

Strategies to Sustain Success in Childhood Immunizations
The National Vaccine Advisory Committee
JAMA 1999;282:363-370.
ABSTRACT | FULL TEXT  

Improving Immunization Rates in Private Pediatric Practices Through Physician Leadership
Sinn et al.
Arch Pediatr Adolesc Med 1999;153:597-603.
ABSTRACT | FULL TEXT  

Assessing Immunization Performance of Private Practitioners in Maine: Impact of the Assessment, Feedback, Incentives, and Exchange Strategy
Massoudi et al.
Pediatrics 1999;103:1218-1223.
ABSTRACT | FULL TEXT  

Immunization Performance Measurement in a Changing Immunization Environment
Rodewald et al.
Pediatrics 1999;103:889-897.
ABSTRACT | FULL TEXT  

Improving Vaccination Coverage Through Accelerated Measurement and Feedback
Schlenker et al.
JAMA 1998;280:1482-1483.
FULL TEXT  

Impact of a Large-Scale Immunization Initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Hoekstra et al.
JAMA 1998;280:1143-1147.
ABSTRACT | FULL TEXT  

Initiating the First DTP Vaccination Age-appropriately: A Model for Understanding Vaccination Coverage
Ross et al.
Pediatrics 1998;101:970-974.
ABSTRACT | FULL TEXT  

Do Missed Opportunities Stay Missed? A 6-Month Follow-up of Missed Vaccine Opportunities in Inner City Milwaukee Children
Sabnis et al.
Pediatrics 1998;101 :e5-e5.
ABSTRACT | FULL TEXT  

National, State, and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months--United States, July 1996-June 1997
JAMA 1998;279:985-986.
FULL TEXT  

The Impact of Interventions by a Community-Based Organization on Inner-city Vaccination Coverage: Fulton County, Georgia, 1992-1993
LeBaron et al.
Arch Pediatr Adolesc Med 1998;152:327-332.
ABSTRACT | FULL TEXT  

A Population-based Study of Access to Immunization Among Urban Virginia Children Served By Public, Private, and Military Health Care Systems
Morrow et al.
Pediatrics 1998;101 :e5-e5.
ABSTRACT | FULL TEXT