KEYWORDS:
Adolescent Immunization, Managed Care

BACKGROUND:
The Kaiser Permanente Medical Center, Los Angeles (KPMC,LA) adopted improving adolescent immunization rates as one of its Clinical Strategic Goals. Using methodology similar to the successful approach used for childhood immunizations, the KPMC,LA has been able to substantially improve adolescent immunization rates and to sustain those gains for one year.

OBJECTIVE:
Our objective was to raise adolescent immunization rates to 60% and to sustain that increase.

METHOD:
A multidisciplinary committee of physicians and non physicians met for one half day. After reviewing the data on adolescent immunizations rates, the committee discussed three questions. Where should we be? What are the barriers to being where we think we should be? What do we need to do, given the barriers identified, to close the gap between where we are to where we would like to be? Four recommendations resulted: chart review by physicians and outreach on all charts of pre-adolescents who are identified by our electronic immunization data system as not being fully immunized; a program for reward and recognition of patients (phone cards were given) and support staff; having the immunization records present at all visits; and a proactive awareness campaign for parents, patients and staff.

RESULT:
Adolescents with complete immunizations (Hepatitis Bx3, MMR after first birthday and a booster after age 4, Varicella vaccine or documented history of varicella) rose from 9% in 1997 to 63% in 2000. This gain has been sustained for over one year. The data for 2002, through the third quarter, has shown an adolescent immunization rate rate of 72%.

CONCLUSION:
An organized approach to increasing adolescent immunization rates can lead to significant sustained increases. The key factor in this approach is review of medical records by physicians and an outreach via letter and telephone to all adolescents who are not fully immunized.

LEARNING OBJECTIVES:
Having an integrated health care delivery system, having paid time for chart review by physicians, having an active outreach program, having accurate documentation in an electronic data system can yield excellent and sustained increases in adolescent immunization rates.