BACKGROUND:
The National Immunization Survey indicated coverage for children age 19-35 months in NYC was 72.7% for the 4:3:1:3:3 series in 2003. When NYC DOHMH analyzed coverage among patients of 52 providers in PON areas, only 43% were immunized by 24 months and 52% by 24-36 months.

OBJECTIVE:
To identify and address barriers to higher coverage among providers in PON areas.

METHOD:
The Assessment Unit analyzed 21 providers in PON areas assessed both in 2003 and 2004; identified barriers; developed recommendations; provided feedbacks; and conducted follow-ups. (Analysis was modified to detect non-compliance with the Recommended Immunization Schedule.)

RESULT:
Coverage for the 21 providers was 41% by 24 months and 50% by 24-36 months in 2003. Findings from 726 charts reviewed indicated that 330 children were missing vaccines; 58% of these children received a total of 278 invalid doses. When analyzing this data without consideration of minimum age and interval, coverage was higher: 54% by 24 months and 65% by 24-36 months. Of the children missing vaccines, 91% had a MOV at last visit and 76% of their providers lacked a recall system. Repeat assessments conducted among the 21 providers in 2004 using a new cohort revealed a significant increase in coverage (57% by 24 months and 70% by 24-36 months). The increase was the result of increasing completion rates (p < .05) and decreasing the number of invalid doses (p < .05). The rate of children missing vaccines and having a MOV remained the same (p > .05).

CONCLUSION:
Coverage improved consistent with a focus on appropriate scheduling and reducing missed opportunities, but further work is needed to raise rates to desired levels.

LEARNING OBJECTIVES:
To understand the role of identifying barriers, developing recommendations and following up with providers in PON areas in improving coverage.