Improving pediatric immunization rates in a safety-net delivery system.
BACKGROUND
Denver Community Health Services (DCHS)' goal was to increase childhood immunization rates in the high-risk pediatric patient population served through its safety-net delivery system. The specific goal of the initiative was to ensure that children younger than 3 years of age with at least one primary care visit received all recommended vaccines by 24 months of age.


METHODS
An immunization registry was developed to accurately track patients, regular assessment of immunization levels were conducted with provision of clinic-specific feedback, and team-based quality improvement meetings were held. The computerized immunization registry assisted in implementing all the remaining improvement activities. For example, improvement of on-time delivery of vaccines in primary care clinics was accomplished through a rules engine in the vaccine registry, standing orders for vaccine delivery, and implementation of vaccine delivery protocols that eliminated missed opportunities.


RESULTS
From 1995 to 2006, Denver Community Health documented a 47% increase in immunization rates for 2-year-old patients and a 26% increase for 1-year-old-patients. Two-year-old immunization rates exceeded 85% by the end of this time period.


CONCLUSIONS
The initiative improved pediatric immunization rates with demonstrated sustainability during a 10-year period. Success is attributed to staff commitment to process improvement activities and use of a patient registry for pediatric immunization delivery.
Melinkovich
Paul
P
Community Health Services, Denver Health and Hospital Authority, USA. Paul.Melinkovich@dhha.org
Hammer
Anne
A
Staudenmaier
Amie
A
Berg
Michele
M
D000554:Ambulatory Care Facilities; D001363:Awards and Prizes; D002675:Child, Preschool; D003120:Colorado; D018672:Community Health Planning / Q000379:methods* / Q000458:organization & administration; D003153:Community Health Services / Q000379:methods*; D006801:Humans; D017589:Immunization Programs / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D007115:Immunization Schedule; D007117:Immunization, Secondary; D007223:Infant; D009936:Organizational Innovation; D012042:Registries; D017010:Reminder Systems