title: Reducing missed opportunities to vaccinate during child health visits. How effective are parent education and case management?
abstract: BACKGROUND
  At child health visits, immunizations that are due are frequently not given. Increased parent understanding of and demand for immunizations may influence providers to not miss these opportunities.
  
  
  OBJECTIVE
  To assess, as part of a larger study of effectiveness of parent education and case management (CM) in raising immunization rates, the intervention's effectiveness at reducing missed opportunities to vaccinate during child health visits.
  
  
  METHODS
  A representative sample of African American newborns and their families from south central Los Angeles, Calif, were randomly assigned to a control or a CM group and observed during the first year of life. Case managers visited and telephoned parents, educating them on the benefits and safety of immunizations, and encouraging them to request immunizations from providers. When the children were at least 1 year of age, parents were interviewed and provider records were abstracted.
  
  
  RESULTS
  Complete records were abstracted for 126 controls and 129 CM group children. For these children, 1092 visits were documented where immunizations were due. Missed opportunities to vaccinate occurred at more than 50% of visits. Case management was associated with a modest reduction in the percentage of visits with missed opportunities in the bivariate analysis but not after adjustment for other covariates. In a logistic regression model, missed opportunities were more frequent at visits with private than public physicians and at acute illness than well-child visits. Missed opportunities were less frequent among children with a history of at least 1 cancelled appointment, and for visits of children with mothers who smoked.
  
  
  CONCLUSIONS
  Missed opportunities were minimally influenced by a home visitation and parent education program. They are primarily determined by issues under the control of the provider. Family- and child-related characteristics, however, do influence the likelihood of a missed opportunity occurring independent of provider factors.
authors.affiliation: RAND, Santa Monica, CA, USA. dwood@gte.net
authors.forename: D
authors.initials: D
authors.lastname: Wood
authors.forename: M
authors.initials: M
authors.lastname: Schuster
authors.forename: C
authors.initials: C
authors.lastname: Donald-Sherbourne
authors.forename: N
authors.initials: N
authors.lastname: Duan
authors.forename: R
authors.initials: R
authors.lastname: Mazel
authors.forename: N
authors.initials: N
authors.lastname: Halfon
mesh_terms: D001741:Black or African American; D019090:Case Management; D006266:Health Education; D006279:Health Maintenance Organizations; D006801:Humans; D007223:Infant; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D010290:Parents; D011331:Private Practice; D015980:Public Health Practice; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*