M. Rudolph Brody1, Steven D. Woods
1, and Ronald Rosengart
2. (1) Pediatrics and the Center for Medical Education, Kaiser Permanente, 4700 Sunset Blvd, Department of Pediatrics, Los Angeles, CA, USA, (2) Center for Medical Education and Department of Pediatrics, Kaiser Permanente Medical Center, 4700 Sunset Blvd, Los Angeles, CA, USA
BACKGROUND:
In 1997, the Pediatric Department at the Kaiser Permanente Medical Center, Los Angeles, initiated a strategy to improve immunization rates in the less than 2 y.o. Following an educational activity four recommendations were adopted. These were: 1) A proactive awareness campaign; 2) Reward and recognition for parents, children and support staff; 3) Immunization record present at all visits; and 4) Monthly chart review by physicians of all 20 month olds who are not fully immunized and an outreach by phone and mail. The most successful action was the physician chart review and outreach.
OBJECTIVE:
The objective was to raise immunization rates.
METHOD:
Once/month the electronic data base is reviewed and charts pulled for all 20 month olds who are not fully immunized. These charts are then reviewed during a one hour conference by pediatricians and pediatric residents for accuracy of the electronic data entry, missed opportunities and errors of commission and omission. During this review physicians discuss immunization practices and observed errors. Those children, who after chart review are found to need further immunizations, are contacted by phone and by mail and advised to come in for the needed immunization(s). A nurse visit, available 7 days/week is utilized to facilitate immunization administration.
RESULT:
Immunization rates which were 63% in 1997 quickly rose to over 90%. These gains have been maintained for 6 years, though 2003 did see some minimal decrease in rates.
CONCLUSION:
Having physicians review charts has increased and sustained immunization rates. Additional benefits of group chart review have included sharing of good immunization practices, facilitation of quick updates on changes in vaccine availability and vaccine schedules, observing missed opportunities and sharing immunization errors of omission and commission. The same type of chart review and outreach has been instituted for adolescents with similar excellent results.
LEARNING OBJECTIVES:
Involving physicians in chart review can be an effective method to improve physician knowledge of successful immunization practice and can significantly improve and maintain immunization rates.