KEYWORDS:
Missed Opportunities to Vaccinate, Assessments, VFC/AFIX, Barriers

BACKGROUND:
Immunization assessments are key to achieving the 90% immunization goal for two-year-olds. Analyzing missed opportunities to vaccinate (MOVs) is considered an invaluable component as it often explains why coverage is lower than expected. Unfortunately, most analyses indicate only MOVs due to lack of simultaneous administration of vaccines, limiting information conveyed. Expanding the MOV analysis enhances its value.

OBJECTIVE(S):
The NYC Department of Public Health Immunization Program analyzed all MOVs determined to have occurred in its VFC/AFIX assessments. The purpose was to determine the most probable reason the MOV occurred, highlight its impact on coverage and use it to change provider behavior.

METHOD(S):
The assessment included a review of each child’s last visit. An MOV occurred vaccines if vaccines were due and the child did not a valid contraindication. The potential reason the MOV occurred was analyzed.

RESULT(S):
Findings from 38 assessments and 2,610 charts analyzed in 2001 indicated that 76% of the 847 two-year-olds incomplete for the series of 4DTaPs, 3 polios, 1 MMR, 3 Hibs, 3 HepBs had an MOV at their last visit. Only 31% were due to lack of simultaneous vaccine administration while 40% were associated with mild illnesses; 12% with a non-acute disposition; 13% had no card or reason. Up-to-date status was incorrectly assessed in 3% of the cases. When specific barriers were identified and individual charts were reviewed, physicians realized the impact MOVs had on coverage.

CONCLUSIONS(S):
Assessments analyzing all reasons for MOVs better reflect clinical practice and enable providers to understand how to overcome barriers and improve coverage. Providers acknowledged the validity of the findings and appreciated learning how to target areas for improvement.

LEARNING OBJECTIVES:
To understand that immunization assessments need to identify reasons for missed opportunities in order to gain insight into why coverage is low and how to improve it.