Effectiveness of pediatric practice consultation on missed opportunities for immunization

Nancy Hughart, Elizabeth Holt, Jorge Rosenthal, Alan Ross, Alison Jones, Virginia Keane, Patrick Vivier, Bernard Guyer

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines. Design: The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed. Results: The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education-only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions. Conclusions: There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities.

Original languageEnglish (US)
Pages (from-to)123-134
Number of pages12
JournalJournal of Urban Health
Volume75
Issue number1
DOIs
StatePublished - Mar 1998

Fingerprint

Immunization
Referral and Consultation
educational program
Pediatrics
Education
Health Maintenance Organizations
vaccination
education
Information Systems
Vaccination
Diphtheria-Tetanus-Pertussis Vaccine
Diphtheria Toxoid
Health Knowledge, Attitudes, Practice
Baltimore
Tetanus Toxoid
Nurse Practitioners
Organized Financing
Financial Management
health
Medical Records

Keywords

  • Children
  • Immunization
  • Missed opportunities
  • Primary care
  • Tracking system
  • Vaccination

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Effectiveness of pediatric practice consultation on missed opportunities for immunization. / Hughart, Nancy; Holt, Elizabeth; Rosenthal, Jorge; Ross, Alan; Jones, Alison; Keane, Virginia; Vivier, Patrick; Guyer, Bernard.

In: Journal of Urban Health, Vol. 75, No. 1, 03.1998, p. 123-134.

Research output: Contribution to journalArticle

Hughart, N, Holt, E, Rosenthal, J, Ross, A, Jones, A, Keane, V, Vivier, P & Guyer, B 1998, 'Effectiveness of pediatric practice consultation on missed opportunities for immunization', Journal of Urban Health, vol. 75, no. 1, pp. 123-134. https://doi.org/10.1007/BF02344934
Hughart, Nancy ; Holt, Elizabeth ; Rosenthal, Jorge ; Ross, Alan ; Jones, Alison ; Keane, Virginia ; Vivier, Patrick ; Guyer, Bernard. / Effectiveness of pediatric practice consultation on missed opportunities for immunization. In: Journal of Urban Health. 1998 ; Vol. 75, No. 1. pp. 123-134.
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