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Effectiveness of pediatric practice consultation on missed opportunities for immunization

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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.

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Author information

Authors and Affiliations

  1. Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health, 624 N. Broadway, 21205, Baltimore, MD

    Nancy Hughart Rn, MPH &  Bernard Guyer MD, MPH

  2. International Health, USA

    Elizabeth Holt DrPH

  3. Biostatistics, USA

    Alan Ross PhD

  4. Health Policy and Management, at the Johns Hopkins School of Hygiene and Public Health, USA

    Alison Jones PhD

  5. National Immunization Program, Centers for Disease Control and Prevention, USA

    Jorge Rosenthal PhD

  6. Department of Pediatrics, University of Maryland School of Medicine, USA

    Virginia Keane MD

  7. Department of Pediatrics, Brown University School of Medicine, USA

    Patrick Vivier MD, PhD

Authors
  1. Nancy Hughart Rn, MPH
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  2. Elizabeth Holt DrPH
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  3. Jorge Rosenthal PhD
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  4. Alan Ross PhD
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  5. Alison Jones PhD
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  6. Virginia Keane MD
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  7. Patrick Vivier MD, PhD
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  8. Bernard Guyer MD, MPH
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Corresponding author

Correspondence to Nancy Hughart Rn, MPH.

Additional information

This study was funded by the Centers for Disease Control and Prevention, contract number 200-90-0850.

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Hughart, N., Holt, E., Rosenthal, J. et al. Effectiveness of pediatric practice consultation on missed opportunities for immunization. J Urban Health 75, 123–134 (1998). https://doi.org/10.1007/BF02344934

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  • DOI: https://doi.org/10.1007/BF02344934

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