Do Immunization Procedures Match Provider Perception? A Study from the South Carolina Pediatric Practice Research Network (SCPPRN)

Background:
Assessing immunization administration in pediatric practices is necessary to improve quality in the delivery of care.

Objectives:
This study evaluated pediatric practices' ability to determine patients' need for and subsequent delivery of immunizations. We also validated survey responses to determine relationships between provider perception of process and actual process.

Methods:
We surveyed the SCPPRN representative for each of 6 pediatric practices about their current immunization procedures. The surveys included questions about immunization assessment, medical record keeping, opportunities for immunization administration, and prompting of both providers and patients. Subsequently, we visited practices to directly observe their immunization delivery process and reviewed their charts to validate survey responses.

Results:
Two of six participating practices reported assessing immunizations rates annually and providing feedback their clinicians. All practices reported a consistently available vaccine supply, immunization records available in 1 location in the medical record, and immunizing at sick visits. All practices reported they were prompted to give immunizations at well visits. Five reported sending reminders of upcoming visits (phone or mail). Three of six practices reported using standing orders for routine immunizations. No practice reported having a recall system in place when children are overdue. After initial on-site observation in the practices, most reported processes were validated except only 1 practice had a single place in the medical record where all immunizations were recorded, and only 2 practices prompted for immunizing at sick visits. Upon record review, the frequency of missed opportunities for providing immunizations at sick visits ranged from 18%-64%.

Conclusions:
Practices' report of immunization delivery processes do not always agree with direct observation. When immunization delivery is suboptimal, verification of processes are necessary to identify opportunities for improvement. Clear concise immunization records and prompting for immunizations at sick visits are strategies that can decrease missed opportunities for immunization.