The 36th National Immunization Conference of CDC

Wednesday, May 1, 2002 - 11:20 AM

Immunization Assessments: More Than A Single Visit

Karin Seastone Stern1, Denise Helen Benkel1, Stephen Friedman1, Paula Francis Crick1, and Frank Roldan2. (1) Immunization Program, NYC Department of Public Health, 2 Lafayette Street, Box 21, New York, NY, USA, (2) CDC, NYC Department of Public Health, 2 Lafayette St., Box 21, New York, NY, USA

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

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.

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

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.

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.

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.

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.

See more of Risk factors for Under-Immunization in Children
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