title: Factors Associated With Missed Opportunities for Influenza Vaccination: Review of Medical Records in a Diverse Sample of Primary Care Clinics, San Diego County, 2010-2011.
abstract: OBJECTIVE
  Annual influenza vaccination rates remain well below health objectives. Most primary care clinic visits present opportunities for vaccination. The purpose of this study was to quantify missed opportunities (MOs) during the entire influenza season. Patients and clinic characteristics associated with vaccination and MOs are identified.
  
  
  METHODS
  Influenza vaccinations recorded in random chart reviews of children 6 months to 5 years and of adults 50 years and older at 6 pediatric and 7 adult primary care clinics were assessed during the 2010-2011 influenza season. Patient-specific MOs accounted for variable timing and number of visits throughout the vaccination season. Data were assessed using descriptive, graphical, proportional hazards regression methods.
  
  
  RESULTS
  Data for 1136 children and 1329 adults were analyzed. By the end of the season, influenza vaccination coverage recorded in medical records reached 56% and 26% for children and adults, respectively. MOs are common throughout the season and rise sharply after December. By the end of the season, 30.2% of children and 44.9% of adults had 2 or more MOs. Characteristics associated with MOs included age, insurance type, number of visits, and type of medical practice.
  
  
  CONCLUSIONS
  Missed opportunities abound, especially after December. Strategies targeting patients most likely to have MOs and encouraging the use standing orders, reminders, and monitoring in order to reduce them need to be sustained.
authors.affiliation: San Diego State University, San Diego, CA, USA.
authors.forename: Djeneba Audrey
authors.initials: DA
authors.lastname: Djibo
authors.affiliation: San Diego State University, San Diego, CA, USA mpeddeco@mail.sdsu.edu.
authors.forename: K Michael
authors.initials: KM
authors.lastname: Peddecord
authors.affiliation: County of San Diego Health and Human Services Agency, San Diego, CA, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Wang
authors.affiliation: County of San Diego Health and Human Services Agency, San Diego, CA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ralston
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Sawyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002140:California; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000517:prevention & control*; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: community health centers; health promotion; immunization; influenza; missed opportunities; pediatrics; practice management; primary care