Matthew F. Daley1, Lori A. Crane
2, Jennifer Barrow
1, Vijayalaxmi Chandramouli
3, Brenda L. Beaty
1, Norma J. Allred
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, Denver, CO, USA, (2) Preventive Medicine & Biometrics, University of Colorado Health Sciences Center, 4200 E 9th Ave, Box B-119, Denver, CO, USA, (3) Children's Outcomes Research Program, The Children's Hospital, Denver, CO, USA, (4) Immunization Services Division, HSREB, National Immunization Program, CDC, 1600 Clifton Rd, ND, Mailstop E-52, Atlanta, GA, USA
BACKGROUND:
Influenza immunization (IZ) of healthy children 6-23 months old was encouraged during 2003-04 and is recommended for 2004-05. It is unknown what practice organizational characteristics and IZ strategies may facilitate implementation of this new recommendation.
OBJECTIVE:
During the 2003-04 influenza season, to 1) determine how organizational factors and IZ strategies relate to practice-level influenza IZ rates among healthy young children; 2) and describe IZ strategies used to accomplish influenza IZ.
METHOD:
This study was conducted in 5 metro Denver pediatric private practices, all participating in a related trial of IZ reminder/recall. Data about IZ strategies were obtained from in-depth interviews with office managers conducted Nov-Dec 2003. To assess organizational characteristics, a structured survey was distributed to all clinic staff/providers Apr-Aug 2004. The survey included questions regarding: staff teamwork, provider teamwork, innovativeness, efficiency, workload, friendliness, leadership, patient-provider relationship, use of preventive care systems, and degree of change in practice personnel and patient load.
RESULT:
Survey response rate was 85% (177/208). All study sites attempted universal influenza IZ in young children. Overall influenza IZ rates for healthy 6-21 month olds were 40%, 54%, 64%, 75%, and 75% across the five sites. Staff/provider-reported organizational characteristics that appeared strongly associated with higher influenza IZ rates included: use of preventive care systems (e.g. reminders); efficiency; teamwork among providers; leadership; positive provider-patient relationships; and work environment friendliness. Characteristics associated with lower IZ rates included higher perceived workload and a higher degree of change in personnel and patient load within the organization. Higher influenza IZ rates were seen in practices that conducted well-organized and efficient “flu clinics.”
CONCLUSION:
Pediatric practices with more cohesiveness, efficiency, and organizational stability appear better able to innovate to respond to changes in vaccination recommendations.
LEARNING OBJECTIVES:
To learn about the organizational characteristics and IZ strategies that facilitate implementation of new IZ recommendations.
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