Tuesday, March 18, 2008

Effect of a Shortened Immunization Schedule, “Done By One”, on Immunization Completeness at 2 Years

Lance Chilton, Young Children's Health Center, 306A San Pablo SE, Albuquerque, NM, USA, Cynthia Rawn, NM Immunization Program, New Mexico Department of Health, Santa Fe, NM, Hubert A. Allen, Consultant to NMDOH/Immunization Program, Hubert Allen and Associates, 720-25 Tramway Lane, NE, Albuquerque, NM, USA, and Anna L. Pentler, New Mexico Immunization Coalition, University of New Mexico, Health Sciences Center, MSC09 5300, Albuquerque, NM, USA.

Learning Objectives for this Presentation:
1. identify benefits of adopting a compressed immunization schedule such as “Done By One.”
2. identify other correlates of medical practices with high immunization rates.
3. identify the importance of analyzing available data to determine a jurisdiction's problems in achieving high immunization rates and to identify possible solutions.

Coincident with a rapid change from giving immunizations largely at Public Health Department sites to giving them at private providers' offices, New Mexico's rates dropped markedly, as measured by CoCASA data and confirmed by the NIS. Through analysis of the data, we identified missed opportunities as one major factor, and noted that completeness dropped markedly after 12 months of age.

Through analysis of practice-specific data, find and apply approaches to increase rates.

We adopted and promoted a “New Mexico Done By One” immunization schedule, different from but compatible with the CDC/AAP/AAFP schedule, and looked for other approaches to poor immunization rates. Using annual CoCASA evaluations of VFC providers, we collected data on use of the Done By One schedule, availability of an “immunization champion” , use of a “shot nurse”, vaccination during visits for minor illnesses, type of practitioner, having an accessible shot record in the chart, and other potential correlates. The dependent variables are immunization completeness at 15 and at 24 months.

Utilization of the “Done By One” schedule was strongly correlated with increased immunization rates at both ages, as were having a pediatric provider, receiving vaccines in a public health or Indian Health site, and having a policy of immunizing children with minor illnesses.

We believe we have demonstrated the effectiveness of the Done By One schedule in immunization settings, as well as the importance of analysis of hypotheses of reasons for less than stellar immunization rates.