Pediatrics · 1996
The contribution of missed opportunities to childhood underimmunization in Baltimore.
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Holt E, Guyer B, Hughart N, Keane V, Vivier P, Ross A, Strobino D
Аннотация
OBJECTIVE: To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage.
DESIGN AND METHODS: We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites.
MAIN OUTCOME MEASURES: Missed opportunities to vaccinate and up-to-date vaccination status.
RESULTS: By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months.
CONCLUSIONS: Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.
DESIGN AND METHODS: We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites.
MAIN OUTCOME MEASURES: Missed opportunities to vaccinate and up-to-date vaccination status.
RESULTS: By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months.
CONCLUSIONS: Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.
Предметные рубрики MeSH
BaltimoreChild Health ServicesChild, PreschoolCohort StudiesCommunity Health ServicesDiphtheria-Tetanus-Pertussis VaccineGastroenteritisHealth PromotionHumansImmunizationIncidenceMeasles VaccineMeasles-Mumps-Rubella VaccineMedical RecordsMumps VaccineOffice VisitsOtitis MediaPoliovirus Vaccine, OralPreventive MedicineRespiratory Tract InfectionsRetrospective StudiesRubella VaccineSkin Diseases, InfectiousVaccinationVaccines, Combined