BACKGROUND:
Complete immunizations for toddlers is an issue of national focus. Currently, national and state of Ohio coverage for the 4:3:1:3:3 series is 75%. Limited data showed our primary care sites had similar results. In early 2002, the Division of General Pediatrics adopted improving immunization rates as a goal. Our Primary Care Network faced the additional challenge that our 3 sites are very different from each other. Despite these differences, they elected to work together to reach the goal.

OBJECTIVE:
To increase the completed immunization rate for 24 month-old children to greater than 90%.

METHOD:
The Network cares for approximately 20,000 children at 3 locations. One site is a large resident continuity clinic located at the main hospital. The second is a smaller neighborhood health center located in an underserved area. The third is a rural practice serving a 3 county area.
On a monthly basis, each location reviews the immunization record of, up to, 30 children for completeness. These children turned 24 months the previous month and were seen in the previous 6 months. The data is then transmitted and tabulated in the central office.
After baseline data was obtained, rapid cycle improvement iniatives were begun using the Plan-Do-Study-Act methodology. Iniatives included use of an immunization registry, standardizing processes, ongoing feedback of results to staff and families, and calling families if immunizations were delinquent.

RESULT:
The baseline immunization rate for children at the 3 sites in February 2002 was 72%. As of November 2003, this rate had increased to 88%.

CONCLUSION:
A significant improvement in immunization rates can be achieved across a diverse primary care network using improvement methodology and simple data tracking and reporting. This improvement can be accomplished without significant capital investment.

LEARNING OBJECTIVES:
The learner will be familiar with basic improvement methodology used in this iniative.

The learner will understand how these methods were used to improve immunization rates and how to apply similar methods in other settings.