Improving the quality of immunization delivery to an at-risk population: a comprehensive approach.
OBJECTIVE
Immunization quality improvement (QI) interventions are rarely tested as multicomponent interventions within the context of a theoretical framework proven to improve outcomes. Our goal was to study a comprehensive QI program to increase immunization rates for underserved children that relied on recommendations from the Centers for Disease Control and Prevention's Task Force on Community Preventive Services and the framework of the Chronic Care Model.


METHODS
QI activities occurred from September 2007 to May 2008 at 6 health centers serving a low-income, minority population in Washington, DC. Interventions included family reminders, education, expanding immunization access, reminders and feedback for providers, and coordination of activities with community stakeholders. We determined project effectiveness in improving the 4:3:1:3:3:1:3 vaccination series (4 diphtheria-tetanus-pertussis vaccines, 3 poliovirus vaccines, 1 measles-mumps-rubella vaccine, 3 Haemophilus influenzae type b vaccines, 3 hepatitis B vaccines, 1 varicella vaccine, and three 7-valent pneumococcal conjugate vaccines) compliance.


RESULTS
We found a 16% increase in immunization rates overall and a 14% increase in on-time immunization by 24 months of age. Improvement was achieved at all 6 health centers and maintained beyond 18 months.


CONCLUSIONS
We were able to implement a comprehensive immunization QI program that was sustainable over time.
Goldberg Center for General and Community Pediatrics, Children's National Medical Center, Washington, DC 20010, USA. lfu@cnmc.org
Linda Y
LY
Fu
Mark
M
Weissman
Rosie
R
McLaren
Cherie
C
Thomas
Jacquelyn
J
Campbell
Jacob
J
Mbafor
Urvi
U
Doshi
Denice
D
Cora-Bramble
D000328:Adult; D002648:Child; D002675:Child, Preschool; D004219:District of Columbia; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000592:standards*; D007115:Immunization Schedule; D007117:Immunization, Secondary; D007223:Infant; D008297:Male; D008913:Minority Groups; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D011203:Poverty; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards*; D014481:United States