BACKGROUND:
Although influenza vaccination is recommended for persons with asthma, many high-risk children remain unvaccinated each flu season. While prior studies suggest that missed opportunities to vaccinate for influenza are common, the degree to which they occur during the optimal influenza vaccination season is not clear.

OBJECTIVE:
To assess rates of influenza vaccination among children with asthma and to document the frequency and timing of missed opportunities to vaccinate.

METHOD:
Retrospective analysis of 2001-2003 administrative claims for 5,993 children 5-18 years old continuously enrolled in the Michigan Medicaid program who met NCQA HEDIS persistent asthma criteria. Office visits and influenza vaccinations were assessed using CPT and ICD-9 CM diagnosis codes during the 2001-2002 and 2002-2003 influenza seasons (October-May). Bivariate analyses were conducted using chi-square tests of association.

RESULT:
In each year studied, 79% of children had at least one office visit during the influenza season. Evidence of influenza vaccination was found for 14% of children during the 2001-02 season, 18% during the 2002-03 season, and 7% in both seasons. For children with no evidence of influenza vaccination, 77% in the 2001-02 season and 75% in the 2002-03 season had at least one missed opportunity. During both influenza seasons, nearly all children (95%) with a missed opportunity had at least one “sick” visit to an outpatient provider and 22% had at least one preventive medicine visit. Most missed opportunities (55%) occurred during the October-November period, which is considered optimal period for influenza vaccination and 77% occurred prior to February, the historical peak of influenza season.

CONCLUSION:
Missed opportunities for influenza vaccination of children with asthma occur frequently during the usual influenza vaccination season. Determining how provider and/or patient barriers may foster missed opportunities is an important step toward improving influenza vaccination rates.

LEARNING OBJECTIVES:
To better understand the nature and timing of missed opportunities to vaccinate high-risk children against influenza.