Matthew F. Daley1, Jennifer Barrow
2, John M. Stevenson
3, Brenda L. Beaty
1, Kellyn Pearson
2, Lori Crane
4, Stephen Berman
1, and Allison Kempe
1. (1) Dept. of Pediatrics, Univ. of Colo. HSC, Children's Outcomes Research Program, The Children's Hospital, 1056 E. 19th Avenue, B032, Denver, CO, USA, (2) Children's Outcomes Research Program, The Children's Hospital, Denver, CO, (3) Centers for Disease Control and Prevention, National Immunization Program, 1600 Clifton Road, NE, MS E-52, Atlanta, Georgia, USA, (4) Department of Preventive Medicine and Biometrics, University of Colorado HSC, 4200 E. 9th Avenue, C245, Denver, CO, USA
BACKGROUND:
Missed opportunities (MOs), in which vaccine-eligible patients are seen for care but not immunized, are an important cause of pediatric underimmunization for routine vaccines. However, the effect of MOs on influenza immunization rates among children with high-risk conditions (HRCs) is less well documented.
OBJECTIVE:
To determine the frequency, timing, and type of visits at which MOs occurred among HRC children needing influenza immunization.
METHOD:
The study was conducted in 4 metropolitan Denver pediatric practices that share a computerized billing system and participate in an immunization registry. For all children age 6-72 months, registry data was linked with billing data. Patients with HRCs were selected using >100 different ICD-9-CM codes, a method we previously established as having 90% accuracy in identifying HRC children within the study practices. A MO was defined as having a billed encounter between October 1, 2002 and January 31, 2003, and being eligible for but not receiving influenza vaccine. Office visits were characterized as either well-child care (WCC) or non-WCC.
RESULT:
We identified n=926 children age 6-72 months with an HRC. During the study period, 25% were vaccinated, 37% had 1 or more MOs, and the remaining 38% had no visit. 85% of all HRC children who received influenza vaccine were immunized in October or November. For vaccine-eligible subjects with 1 or more visits within a given month, the likelihood of being immunized declined dramatically during the study period: 42% likelihood in October, 40% in November, 18% in December, and 4% in January. Among the 343 subjects with MOs, 221 (64%) had MOs only at non-WCC visits, 53 (15%) had MOs at WCC visits, and the remaining 69 (20%) had MOs at both visit types. Among subjects with MOs, 170 (50%) had only 1 visit, 87 (25%) had 2 visits, and 86 (25%) had 3 or more visits.
CONCLUSION:
Missed opportunities for influenza vaccination are common in children with chronic medical conditions. Interventions to reduce MOs, such as provider and patient reminder systems and education regarding immunizing at all types of visits and throughout the influenza season, may substantially increase influenza immunization rates in this vulnerable population.
LEARNING OBJECTIVES:
To document the impact of MOs on influenza immunization in children with HRCs.