Quality improvement in immunization delivery following an unsuccessful immunization recall.
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.
Daley
Matthew F
MF
Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO 80218, USA. daley.matthew@tchden.org
Steiner
John F
JF
Kempe
Allison
A
Beaty
Brenda L
BL
Pearson
Kellyn A
KA
Jones
Jennifer S
JS
Lowery
N Elaine
NE
Berman
Stephen
S
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