BACKGROUND:
In 2003 the Missouri Department of Health and Senior Services establised the Immunization Quality Improvement Workgroup to improve childhood immunization rates. This workgroup consisted of statewide immunization staff, AFIX representatives from the Missouri Primary Care Association, the Missouri Chapter of the American Academy of Pediatrics, and local public health departments.

OBJECTIVE:
To increase immunization rates for the 4:3:1:3:3:1 series in children 19-35 months in Missouri from 60.1% in 2002 to 80% by 2005.

METHOD:
The Missouri Immunization QI Workgroup formed in mid-2003. The purpose of this group was to learn about CQI, and to implement an improvement project in immunization rates through creating specific standards, objectives, and policies and procedures for Missouri. A QA Site Visit Quality Assurance Guide was created and implemented in 2004. National Immunization Survey data is our measurement for improvement.

RESULT:
In 2003 NIS data indicated Missouri had a 74.4% coverage rate for the 4:3:1:3:3:1 immunization series. The national average was 72.5%.

CONCLUSION:
Continuous quality improvement can make a difference in immunization rates.
The right players must be involved and committed for CQI to be effective.
CQI is more effective if supported from all levels.
Standardization of a vision, objectives, and policies and procedures can improve immunization rates.
AFIX equals CQI.
Simplifying CQI to its component parts can help groups to understand and implement the process.
Outcomes must be determined and monitored in order for CQI to be effective.

LEARNING OBJECTIVES:
Define CQI.
Simplify CQI.
Compare CQI to AFIX.
Provide tools by which to create improvement.
Share challenges, successes and next steps.