title: Quality improvement in immunization delivery following an unsuccessful immunization recall.
abstract: OBJECTIVE
  Within a clinic serving disadvantaged children, 1) to evaluate a multifaceted quality improvement (QI) project to improve immunization (IZ) up-to-date (UTD) rates and 2) to assess the efficacy of IZ reminder/recall performed following QI.
  
  
  METHODS
  A year-long QI project followed by a trial of reminder/recall. QI interventions were targeted at previously identified barriers to IZ and were designed specifically to improve the efficacy of reminder/recall. QI interventions were designed to 1) increase the use of medical record releases to document IZs received elsewhere; 2) improve the accuracy of parental contact information; and 3) reduce missed opportunities by utilizing chart prompts, provider education, and provider reminders. Following QI, we conducted a randomized trial of reminder/recall.
  
  
  RESULTS
  UTD rates for 7-11 month olds increased from 21% before the QI project to 52% after (P <.0001); rates for 12-18 month olds increased from 16% before QI to 44% after (P <.0001); 19-25 month olds 18% before to 33% after (P <.001). After QI, an average of 61 records per month were updated with IZs received elsewhere. However, the accuracy of parental contact information worsened (29% unreachable before QI vs 44% after, P <.001) and missed opportunities did not improve (8% before vs 6% after, P = not significant [NS]). A subsequent trial of reminder/recall did not increase UTD rates, with 17% of recalled children brought UTD vs 16% of controls (P = NS).
  
  
  CONCLUSIONS
  Clinic-based QI increased documented UTD rates in a disadvantaged patient population. However, IZ reminder/recall did not further increase UTD rates above the rates achieved by the QI process.
authors.affiliation: Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO 80218, USA. daley.matthew@tchden.org
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: Kellyn A
authors.initials: KA
authors.lastname: Pearson
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Jones
authors.forename: N Elaine
authors.initials: NE
authors.lastname: Lowery
authors.forename: Stephen
authors.initials: S
authors.lastname: Berman
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D007223:Infant; D005791:Patient Care / Q000592:standards; D011785:Quality Assurance, Health Care