KEYWORDS:
Immunization Assessments, AFIX, Follow-up, Feedback, Outcome

BACKGROUND:
Immunization assessments are conducted to improve coverage. Unfortunately, assessments are often limited to a single visit, do not follow-up on children identified as under-immunized and/or explore if the provider implemented any recommendations. Subsequent assessments, conducted on another cohort, do not always address issues from the prior assessment. Increasing the number of visits to follow-up on the outcome increases the usefulness of the assessment.

OBJECTIVE(S):
Utilize assessments to increase coverage for children identified as under-immunized and assist providers to incorporate changes in their practices.

METHOD(S):
NYC DOH Assessment Feedback Report listed the children missing vaccines in the 4:3:1:3:3 series (4DTPs, 3Polios, 1MMR, 3Hibs, 3HepBs) and outlined practice-specific recommendations to overcome barriers. A follow-up visit scheduled approximately 2 months after the assessment determined the outcome of recalling the under-immunized children identified in the assessment and the providers' progress in implementing the practice-specific recommendations outlined in the report.

RESULT(S):
Coverage for 18-35 month-olds significantly increased (p<.01) for the 4:3:1:3:3 series by 16% within 11 weeks following the date of the assessment at 14 VFC practices assessed in 2001. (Average coverage, 90%.) Providers realized the impact of the assessment after they attempted to follow-up on the children overdue for vaccines. Issues that needed further clarification (e.g., interval between doses) were also discussed.

CONCLUSIONS(S):
Even when providers agree that assessment coverage was lower than expected, they do not necessarily implement changes to their practices or update children’s immunization coverage. Scheduling a follow-up visit to review charts of a specific group of under-immunized children serves as an incentive to institute changes to providers’ practices and behavior to enable coverage to increase.

LEARNING OBJECTIVES:
To understand that follow-up of under-immunized children and that more than a single visit are needed for a provider to implement changes recommended in VFC/AFIX assessments.