KEYWORDS:
practice assessment, provider behavior, quality improvement, clinic systems

BACKGROUND:
In order to achieve and sustain national immunization goals, attention has turned toward studying clinic systems and interventions that effect physician behavior changes within the clinic system. The Partnership of Immunization Providers (PIP) is one of four CDC-funded demonstration projects partnering academic medical centers and community health networks to evaluate new approaches for improving immunization delivery to young children.

OBJECTIVE(S):
To evaluate the effectiveness of provider-focused interventions designed to improve the delivery of immunizations to young children in urban practices serving a poor population in San Diego County.

METHOD(S):
This demonstration project consisted of multiple interventions and measures of both outcome and process in fourteen practice sites, composed of private provider offices, non-profit community clinics, and university-based primary care clinics in San Diego County. Interventions included audit and feedback, workflow analysis, missed opportunity chart analysis, education and training.

RESULT(S):
Immunization coverage rates (4DTP:3Polio:3 HIB:3HEPB:1MMR) increased from 26.4% to 47.8% at 16 months of age in nine Phase I sites; and increased from 30.2% to 38.8% in five Phase II sites; missed immunization opportunities decreased from 66.8% to 49.6% at 16 months of age in Phase I sites; from 56.5% to 44.6%, then rose to 62.9% in Phase II sites. We observed a positive attitude about immunizations among our providers but a low self-efficacy for changing the delivery of immunization. We also documented deficits in immunization knowledge among providers and inadequate clinic systems to support the delivery of immunizations.

CONCLUSIONS(S):
Multiple factors contribute to provider immunization practice. The delivery of childhood immunizations to poor urban children can be improved by addressing provider behavior and making changes in clinic systems.

LEARNING OBJECTIVES:
List interventions that are effective in improving immunization delivery to young children in poor urban communities.