Assessing immunization performance of private practitioners in Maine: impact of the assessment, feedback, incentives, and exchange strategy.
BACKGROUND
A provider-based vaccination strategy that has strong supportive evidence of efficacy at raising immunization coverage level is known as Assessment, Feedback, Incentives, and Exchange. The Maine Immunization Program, and the Maine Chapter of the American Academy of Pediatrics collaborated on the implementation and evaluation of this strategy among private providers.


METHODS
Between November 1994 and June 1996, the Maine Immunization Program conducted baseline immunization assessments of all private practices administering childhood vaccines to children 24 to 35 months of age. Coverage level assessments were conducted using the Clinic Assessment Software Application. Follow-up assessments were among the largest practices, delivering 80% of all vaccines.


RESULTS
Of the 231 practices, 58 were pediatric and 149 were family practices. The median up-to-date vaccination coverages among all providers for 3 doses of diphtheria-tetanus-pertussis vaccine and 2 doses of oral polio vaccine, and 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at age 12 and 24 months were 90% and 78%, respectively, and did not vary by number of providers in a practice or by specialty. Urban practices had higher coverage than rural practices at 12 months (92% vs 88%). The median up-to-date coverage for 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at 24 months of age improved significantly among those practices assessed 1 year later (from 78% at baseline to 87% at the second assessment). On average, the assessments required 21/2 person-days of effort.


CONCLUSIONS
We document the feasibility and impact of a public/private partnership to improve immunization delivery on a statewide basis.


CONCLUSIONS
Other states should consider using public/private partnerships to conduct private practice assessments. More cost-effective methods of assessing immunization coverage levels in private practices are needed.
Massoudi
M S
MS
Centers for Disease Control and Prevention, National Immunization Program, Atlanta, Georgia, USA. mrm8@cdc.gov
Walsh
J
J
Stokley
S
S
Rosenthal
J
J
Stevenson
J
J
Miljanovic
B
B
Mann
J
J
Dini
E
E
D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005246:Feedback; D005500:Follow-Up Studies; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D007223:Infant; D008281:Maine; D009042:Motivation; D010818:Practice Patterns, Physicians'; D011331:Private Practice / Q000592:standards*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data