Learning Objectives for this Presentation:
1.To compare knowledge of catch-up regimen design and valid contraindications for childhood vaccinations among Houston Vaccines for Children (VFC) providers with low (<70%) and high (≥80%) immunization coverage levels for the 4:3:1:3:3 vaccination series.
2.Define and identify missed opportunities to vaccinate.
3.Understand which provider and practice-based characteristics may be associated with maximizing, omitting, or administering an unnecessary vaccination.

Background:
In 2004, Houston had one of the lowest childhood immunization levels among major metropolitan cities in the United States at 65% for the 4:3:1:3:3 vaccination series. Delays in the receipt of scheduled vaccinations may be related to missed opportunities due to health care provider lack of knowledge about catch-up regimens and contraindications for pediatric vaccination.

Objectives:
To compare knowledge of catch-up regimen design and valid contraindications for childhood vaccinations among Houston Vaccines for Children (VFC) providers with low (<70%) and high (≥80%) immunization coverage levels for the 4:3:1:3:3 vaccination series.

Methods:
VFC provider knowledge of catch-up regimen design and contraindications was gathered from a set of vignettes administered to study participants. Two groups were formed to allow for a comparison of catch up regimen design and valid contraindication identification between low and high immunizing VFC providers.

Results:
VFC providers from both groups had difficulty designing catch-up regimens from memory: 16% in the low coverage group and 17.6% in the high coverage group. Hib and PCV were inappropriately proposed for patient administration most frequently by both coverage groups. VZV and MMR were the two vaccines that low and high coverage providers omitted most frequently.

Conclusions:
VFC providers who practiced reminder recall and flagged immunization records were more likely to maximize the number of injections that could be given at visit 1. VFC providers who evaluated more than 36 patients per day were less likely to maximize the number of injections that could be given at visit 2.