A Collaborative Intervention to Identify Child Presenting for Sick Visits Who Need Vaccines

Background:
Studies have shown that missed opportunities to vaccinate reduce immunization rates among poor, urban children. Sick visits to pediatricians often constitute missed opportunities to vaccinate.

Setting:
This program was a collaboration between the Children's National Medical Center Child Health Advocacy Institute, the hospital's pediatric primary care clinic and the Washington, DC Department of Public Health. It took place in the clinic and was part of a broader effort to increase vaccination rates among preschool children. Prior to this intervention, clinic practitioners did not routinely review the vaccine records of children presenting for sick visits to determine if they required any vaccinations.

Population:
The primary care clinic serves children ages 0 to 11 years old, who are predominantly African-American and insured by Medicaid.

Project Description:
Health educators examined the vaccination records of children who came to the clinic for sick visits and identified children who required vaccines according the to Advisory Committee on Immunization Practices (ACIP) recommendations. For children behind in their vaccinations, copies of vaccine records were printed so they were available to the pediatricians and nurse practitioners during the visits. The pediatricians and nurse practitioners were instructed to use every appropriate opportunity to vaccinate children who needed vaccines.

Results/Lessons Learned:
Health educators were able to identify children presenting for sick visits who needed vaccinations. For the nine-month period from January to September 2008, the vaccination records of 305 children presenting to the clinic for sick visits were reviewed. These children needed a total of 1,234 vaccines or an average of 4 vaccines per child. Records are being reviewed to determine the extent to which practitioners gave the vaccines indicated for each child.