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Improving Vaccination Coverage Through Accelerated Measurement and Feedback
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To the Editor.—A previous study documented success in improving immunization rates of 136000 children served by 200 public health clinics in Georgia through the application of a 7-year program of "measurement and feedback."1 This measurement and feedback program consisted of annual sampling of charts to determine the proportion of 2-year-olds up-to-date on their immunizations at each clinic, communication of clinic-specific rates, including their rank order, and awards for best performers.2 From 1988 to 1994, up-to-date rates increased from 53% to 89%.
Such an impressive improvement in rates was especially welcome news in the aftermath of the nationwide measles epidemic that occurred between 1989 and 1991, which left exposed the dismal state of vaccine coverage among preschool-aged children in the United States.3 However, Georgia's effort was an uncontrolled, long-term, "natural" experiment termed "real-time science as seen in the plan-do-study-act cycle of quality improvement,"4 which was potentially affected by any number . . . [Full Text of this Article]
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