title: The impact of missed opportunities on seasonal influenza vaccination coverage for healthy young children.
abstract: OBJECTIVE
  To estimate the impact of missed opportunities on influenza vaccination coverage among 6- through 23-month-old children who sought medical care during the 2004-2005 influenza season.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Fifty-two primary care practice sites located in Rochester, New York, Nashville, Tennessee, and Cincinnati, Ohio.
  
  
  METHODS
  Children 6 through 23 months of age. METHODS/OUTCOME MEASURE: Charts were reviewed and data collected on influenza vaccinations, type of health care visit (well child or other), and presence of illness symptoms. Missed opportunity was defined as a practice visit by an eligible child during influenza season, when vaccine was available, but during which the child did not receive an influenza vaccination. Vaccine was assumed to be available between the first and last dates influenza vaccination was recorded at that practice. Each child was classified as fully vaccinated, partially vaccinated, or unvaccinated.
  
  
  RESULTS
  Data were analyzed for 1724 children, 6 through 23 months of age. Most children (62.0%) had at least 1 missed opportunity during this period. Among children with any missed opportunities, 12.8% were fully and 29.8% were partially vaccinated. Overall, 33.6% of the missed opportunities occurred during well child visits and 66.4% during other types of visits; 75% occurred when no other vaccines were given. Eliminating all missed opportunities would have increased full vaccination coverage from 30.3% to 49.9%.
  
  
  CONCLUSIONS
  Missed opportunities for influenza vaccination are frequent. Reducing missed opportunities could significantly increase influenza vaccination rates and should be a goal in each practice.
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. nallred@cdc.gov
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Allred
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Poehling
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.forename: Mary Allen
authors.initials: MA
authors.lastname: Staat
authors.forename: Stephanie
authors.initials: S
authors.lastname: Donauer
authors.forename: Mila M
authors.initials: MM
authors.lastname: Prill
authors.forename: Gerry
authors.initials: G
authors.lastname: Fairbrother
mesh_terms: D015331:Cohort Studies; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D009980:Influenza A virus / Q000187:drug effects*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008485:Medical Audit; D012189:Retrospective Studies; D012621:Seasons; D014481:United States
chemical_list: D007252:Influenza Vaccines