Kellyn Pearson1, Lori A Crane
2, Kathleen Haas
1, Allison Kemp
3, Elaine Lowery
1, John F. Steiner
2, and Stephen Berman
3. (1) Pediatrics, University of Colorado Health Sciences, Colorado Rural Immunization Services, 12477 E. 19th Avenue, Bldg. 406, Aurora, USA, (2) Preventative Medicine & Biometrics, University of Colorado Health Sciences Center, 4200 E 9th Ave, Box C-=245, Denver, CO, USA, (3) Pediatrics, University of Colorado Health Sciences Center, The Children's Hospital, 1056 E 19th Ave, Box B-032, Denver, CO, USA
KEYWORDS:
immunizations, registry, UTD
BACKGROUND:
To improve the delivery and documentation of immunizations, it is necessary to understand organizational characteristics in medical offices.
OBJECTIVE(S):
Identify office characteristics that affect delivery and documentation of immunizations.
METHOD(S):
Based on qualitative research conducted by Crabtree and colleagues, we developed and administered a structured questionnaire to 166 office personnel at 32 medical offices in rural Colorado (response rate=75%). We identified 8 scales representing office characteristics: provider satisfaction, office support of preventive services, focus on innovation, teamwork, work load, friendliness/cohesiveness of staff, and leadership. We computed an index of organization change for the prior 12 months. Practice level UTD rate was obtained by chart review and calculated using CASA software. Error rate was determined by comparing the medical record to the immunization registry.
RESULT(S):
High work load was negatively related to UTD rates (r=-0.23, p=0.005), as was high organizational change over the past year (r=-0.15, p=0.08). Office staff friendliness was positively related (r=0.20, p=.005). The other six practice characteristics measured were not related to UTD rates. Higher innovation was associated with a lower error rate (r=-0.21, p=.008). Higher error rate was associated with higher workload (r=0.28, p=.0006) and higher organization change (r=0.19, p=.03).
CONCLUSIONS(S):
These findings support the view that high levels of practice change (as measured by practitioner and staff turnover, and changes in patient load, payor affiliations and ownership) are related to high levels of work load and stress, and these factors have a negative impact on the delivery and documentation of immunizations. Efforts to improve delivery of immunization services and implementation of immunization registries may be more successful if practices address high work load and stress prior to the introduction of office systems aimed at improving immunization services.
LEARNING OBJECTIVES:
Identify office characteristics that affect office specific UTD rates and error rates in an immunization registry.
See more of A Provider’s Perspective on Immunization Registries
See more of The 36th National Immunization Conference
