Missed Opportunities for Childhood Vaccinations in Office Practices and the Effect on Vaccination Status
1 From the Division of General Pediatrics, Strong Memorial Hospital, The University of Rochester School of Medicine and Dentistry, Rochester, NY.
2 From the Division of General Pediatrics, Department of Emergency Medicine, Strong Memorial Hospital, The University of Rochester School of Medicine and Dentistry, Rochester, NY.
3 From the Department of Emergency Medicine, Strong Memorial Hospital, The University of Rochester School of Medicine and Dentistry, Rochester, NY.
4 From the Department of Biostatistics, Strong Memorial Hospital, The University of Rochester School of Medicine and Dentistry, Rochester, NY.
5 From the School of Nursing, Strong Memorial Hospital, The University of Rochester School of Medicine and Dentistry, Rochester, NY.
6 From the Infectious Disease Division of the Department of Pediatrics, Strong Memorial Hospital, The University of Rochester School of Medicine and Dentistry, Rochester, NY.
To determine the rate of childhood undervaccination, rate and types of missed opportunities (MOs) for vaccinations, and the contribution of MOs to the undervaccination of preschool-age children, the authors conducted a retrospective medical chart review in seven primary care settings in the Rochester, NY, area: a hospital clinic, a neighborhood health center, a group-model health maintenance organization, an urban group practice, a suburban group practice, a rural health center, and a rural private practice. The random sample included 1124 children having birth dates between March 15, 1988, and September 15, 1989. The main outcome measures were cumulative undervaccination rate, defined as the proportion of patients from each practice who were ever >60 days past-due for a vaccination by 12, 18, or 24 months of age; undervaccination time, defined as the median number of months during which children were undervaccinated; number of MOs; visit types and conditions associated with the MOs; and the duration of undervaccination time attributable to MOs. The cumulative undervaccination rate by 12 months was at least 20% in each practice except for the suburban practice, where it was 4%. The frequency of MOs varied from a high of 1.8 MO per patient per year at the rural private practice to a low of 0.3 MO per patient per year at the suburban practice. More than one quarter of MOs occurred during either health supervision or follow-up visits in all practices. In 28% of visits during which an MO occurred, patients had no fever or acute illness. The impact of MOs was twice as great for children having Medicaid or no health insurance as for children covered by private insurance. Missed opportunities contributed 13% of the total undervaccination time in the suburban practice, 27% in the clinic, and more than 40% in the other practices. It is concluded that missed opportunities for vaccination occur frequently and contribute significantly to the undervaccination of preschool children. The effect of MOs is greatest in practices serving impoverished children. Reducing MOs would substantially improve the vaccination levels of preschool-age children.
Key Words: preschool children • vaccination • immunization
Submitted on May 8, 1992
Accepted on July 20, 1992
This article has been cited by other articles:
 |
|
 |
|
  C. M. Rand, P. G. Szilagyi, B.-K. Yoo, P. Auinger, C. Albertin, and M. S. Coleman Additional Visit Burden for Universal Influenza Vaccination of US School-Aged Children and Adolescents Arch Pediatr Adolesc Med, November 1, 2008; 162(11): 1048 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. V. Lavigne, S. A. LeBailly, K. R. Gouze, C. Cicchetti, J. Pochyly, R. Arend, B. W. Jessup, and H. J. Binns Treating Oppositional Defiant Disorder in Primary Care: A Comparison of Three Models J. Pediatr. Psychol., June 1, 2008; 33(5): 449 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Fiks, K. F. Hunter, A. R. Localio, R. W. Grundmeier, and E. A. Alessandrini Impact of Immunization at Sick Visits on Well-Child Care Pediatrics, May 1, 2008; 121(5): 898 - 905. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Schor Should Children With Special Health Care Needs Have Separate Preventive Care Visits? Arch Pediatr Adolesc Med, December 1, 2007; 161(12): 1216 - 1218. [Full Text] [PDF]
|
|
|
|
|
|
A. G. Fiks, R. W. Grundmeier, L. M. Biggs, A. R. Localio, and E. A. Alessandrini Impact of Clinical Alerts Within an Electronic Health Record on Routine Childhood Immunization in an Urban Pediatric Population Pediatrics, October 1, 2007; 120(4): 707 - 714. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Fiks, E. A. Alessandrini, A. A. Luberti, S. Ostapenko, X. Zhang, and J. H. Silber Identifying Factors Predicting Immunization Delay for Children Followed in an Urban Primary Care Network Using an Electronic Health Record Pediatrics, December 1, 2006; 118(6): e1680 - e1686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Szilagyi, M. R. Griffin, L. P. Shone, R. Barth, Y. Zhu, S. Schaffer, S. Ambrose, J. Roy, K. A. Poehling, K. M. Edwards, et al. The Impact of Conjugate Pneumococcal Vaccination on Routine Childhood Vaccination and Primary Care Use in 2 Counties Pediatrics, October 1, 2006; 118(4): 1394 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Szilagyi, M. K. Iwane, S. Schaffer, S. G. Humiston, R. Barth, T. McInerny, L. Shone, and B. Schwartz Potential Burden of Universal Influenza Vaccination of Young Children on Visits to Primary Care Practices Pediatrics, October 1, 2003; 112(4): 821 - 828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Sabnis, A. J. Pomeranz, and M. M. Amateau The Effect of Education, Feedback, and Provider Prompts on the Rate of Missed Vaccine Opportunities in a Community Health Center Clinical Pediatrics, March 1, 2003; 42(2): 147 - 151. [Abstract] [PDF]
|
|
|
|
|
|
J. A. Gaudino, M. P. deHart, A. Cheadle, D. P. Martin, D. L. Moore, S. J. Schwartz, and B. Schulman Childhood Immunization Registries: Gaps Between Knowledge and Action Among Family Practice Physicians and Pediatricians in Washington State, 1998 Arch Pediatr Adolesc Med, October 1, 2002; 156(10): 978 - 985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Brenner, B. G. Simons-Morton, B. Bhaskar, A. Das, J. D. Clemens, and the NIH-D.C. Initiative Immunization Working Group Prevalence and Predictors of Immunization Among Inner-City Infants: A Birth Cohort Study Pediatrics, September 1, 2001; 108(3): 661 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Bordley, P. A. Margolis, J. Stuart, C. Lannon, and L. Keyes Improving Preventive Service Delivery Through Office Systems Pediatrics, September 1, 2001; 108(3): e41 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Lieu, R. L. Davis, A. M. Capra, L. K. Mell, C. P. Quesenberry, K. E. Martin, A. Zavitkovsky, S. B. Black, H. R. Shinefield, R. S. Thompson, et al. Variation in Clinician Recommendations for Multiple Injections During Adoption of Inactivated Polio Vaccine Pediatrics, April 1, 2001; 107(4): e49 - e49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Minkovitz, A. D. Belote, S. M. Higman, J. R. Serwint, and J. P. Weiner Effectiveness of a Practice-Based Intervention to Increase Vaccination Rates and Reduce Missed Opportunities Arch Pediatr Adolesc Med, March 1, 2001; 155(3): 382 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hack, D. Wilson-Costello, H. Friedman, G. H. Taylor, M. Schluchter, and A. A. Fanaroff Neurodevelopment and Predictors of Outcomes of Children With Birth Weights of Less Than 1000 g: 1992-1995 Arch Pediatr Adolesc Med, July 1, 2000; 154(7): 725 - 731. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Kahane, J. P. Watt, K. Newell, S. Kellam, S. Wight, N. J. Smith, A. Reingold, and R. Adler Immunization Levels and Risk Factors for Low Immunization Coverage Among Private Practices Pediatrics, June 1, 2000; 105(6): 73e - 73. [Abstract] [Full Text]
|
|
|
|
|
|
C. Minkovitz, E. Holt, N. Hughart, W. Hou, L. Thomas, E. Dini, and B. Guyer The Effect of Parental Monetary Sanctions on the Vaccination Status of Young Children: An Evaluation of Welfare Reform in Maryland Arch Pediatr Adolesc Med, December 1, 1999; 153(12): 1242 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. LeBaron, L. Rodewald, and S. Humiston How Much Time Is Spent on Well-Child Care and Vaccinations? Arch Pediatr Adolesc Med, November 1, 1999; 153(11): 1154 - 1159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. T. Rust, F. A. Sisk, A. R. Kuo, J. Smith, R. Miller, and K. M. Sullivan Impact of Resident Feedback on Immunization Outcomes Arch Pediatr Adolesc Med, November 1, 1999; 153(11): 1165 - 1169. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The National Vaccine Advisory Committee Strategies to Sustain Success in Childhood Immunizations JAMA, July 28, 1999; 282(4): 363 - 370. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Hambidge, S. A. Easter, S. Martin, P. Melinkovich, J. Brown, and C. D. Siegel Characteristics of Families Who Attend Free Vaccine Fairs Pediatrics, July 1, 1999; 104(1): 158 - 163. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. Mcllvenny and J. Barr Immunisation coverage at a well-baby clinic in the United Arab Emirates Perspectives in Public Health, June 1, 1999; 119(2): 97 - 100. [Abstract] [PDF]
|
|
|
|
|
|
S. L. Udovic, T. A. Lieu, S. B. Black, P. M. Ray, G. T. Ray, and H. R. Shinefield Parent Reports on Willingness to Accept Childhood Immunizations During Urgent Care Visits Pediatrics, October 1, 1998; 102(4): e47 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R Evans and D. R. Thomas A retrospective cohort study of risk factors for missing preschool booster immunisation Arch. Dis. Child., August 1, 1998; 79(2): 141 - 144. [Abstract] [Full Text]
|
|
|
|
|
|
A. Ross, A. B. Kennedy, E. Holt, B. Guyer, W. Hou, and N. Hughart Initiating the First DTP Vaccination Age-appropriately: A Model for Understanding Vaccination Coverage Pediatrics, June 1, 1998; 101(6): 970 - 974. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Sabnis, A. J. Pomeranz, P. S. Lye, and M. M. Amateau Do Missed Opportunities Stay Missed? A 6-Month Follow-up of Missed Vaccine Opportunities in Inner City Milwaukee Children Pediatrics, May 1, 1998; 101 (5): e5 - e5. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Bates and F. D. Wolinsky Personal, Financial, and Structural Barriers to Immunization in Socioeconomically Disadvantaged Urban Children Pediatrics, April 1, 1998; 101(4): 591 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Wood, M. Schuster, C. Donald-Sherbourne, N. Duan, R. Mazel, and N. Halfon Reducing Missed Opportunities to Vaccinate During Child Health Visits: How Effective Are Parent Education and Case Management? Arch Pediatr Adolesc Med, March 1, 1998; 152(3): 238 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Schaffer, J. R. Campbell, P. G. Szilagyi, and M. Weitzman Lead Screening Practices of Pediatric Residents Arch Pediatr Adolesc Med, February 1, 1998; 152(2): 185 - 189. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Cohen Reis and R. Holubkov Vapocoolant Spray Is Equally Effective as EMLA Cream in Reducing Immunization Pain in School-aged Children Pediatrics, December 1, 1997; 100(6): e5 - e5. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Bell, M. Pritchard, R. Anderko, and R. Levenson A Program to Immunize Hospitalized Preschool-aged Children: Evaluation and Impact Pediatrics, August 1, 1997; 100(2): 192 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. N. Ortega, S. F. Andrews, S. H. Katz, S. A. Dowshen, W. S. Curtice, M. E. Cannon, D. C. L. Stewart, and K. Kaiser Comparing a Computer-based Childhood Vaccination Registry with Parental Vaccination Cards: A Population-based Study of Delaware Children Clinical Pediatrics, April 1, 1997; 36(4): 217 - 221. [Abstract] [PDF]
|
|
|
|
|
|
L. England, R. Shelton, and C. J. Schubert Immunizing Preschool Children: Beliefs and Practices of Pediatric Residents Clinical Pediatrics, March 1, 1997; 36(3): 129 - 134. [Abstract] [PDF]
|
|
|
|
|
|
J. A. Taylor, P. M. Darden, E. Slora, C. M. Hasemeier, L. Asmussen, and R. Wasserman The Influence of Provider Behavior, Parental Characteristics, and a Public Policy Initiative on the Immunization Status of Children Followed by Private Pediatricians: A Study From Pediatric Research in Office Settings Pediatrics, February 1, 1997; 99(2): 209 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Siegel and C. J. Schubert Physician Beliefs and Knowledge About Vaccinations: Are Cincinnati Doctors Giving Their Best Shot? Clinical Pediatrics, February 1, 1996; 35(2): 79 - 83. [Abstract] [PDF]
|
|
|
|
 |
|
 M. J. Lanska, D. J. Lanska, R. J. Baumann, and R. J. Kryscio A population-based study of neonatal seizures in Fayette County, Kentucky Neurology, April 1, 1995; 45(4): 724 - 732. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Ball Toddler Documentation Gap Clinical Pediatrics, January 1, 1995; 34(1): 54 - 56. [PDF]
|
|
|
|
 |
|
 J. M. Lyznicki and R. C. Rinaldi Childhood Immunizations and the Vaccines for Children Program Arch Fam Med, August 1, 1994; 3(8): 728 - 730. [Abstract] [PDF]
|
|
|
|
|
|
W. J. Hueston, A. G. Mainous III, and J. B. Farrell Childhood Immunization Availability in Primary Care Practices: Effects of Programs Providing Free Vaccines to Physicians Arch Fam Med, July 1, 1994; 3(7): 605 - 609. [Abstract] [PDF]
|
|
|
|
|
|
S. T. Melman, T. Chawla, J. M. Kaplan, and R. D. Anbar Multiple Immunizations: Ouch! Arch Fam Med, July 1, 1994; 3(7): 615 - 617. [Abstract] [PDF]
|
|
|
|
|
|
J. R. Campbell, P. G. Szilagyi, L. E. Rodewald, C. Doane, and K. J. Roghmann Patient-Specific Reminder Letters and Pediatric Well-Child-Care Show Rates Clinical Pediatrics, May 1, 1994; 33(5): 268 - 272. [Abstract] [PDF]
|
|
|
|
 |
|
 VACCINATION OPPORTUNITIES ARE OFTEN MISSED Journal Watch (General), January 20, 1993; 1993(120): 5 - 5. [Full Text]
|
|
