Immunization Assessments: More Than a Single Visit

1
Immunization Assessments More Than a Single
Visit

• NYC Department of Health Immunization Program

2
Assessments More Than A Single Visit Karin
Seastone Stern, DrPH,Director Clinic
Assessments Denise Benkel, MD, MPH, Medical
Specialist, Child Health Initiative Stephen
Friedman, MD MPH, Assistant Commissioner Paula
Francis-Crick, IAP Assessment Team Member Frank
Roldan, CDC, Program Operations Director For
more information contact kstern_at_health.nyc.gov
3
NYC

• 5 Boroughs
• 722 miles of subway
• 108,000 2-Year Olds
• 1,200 VFC Private Providers
• 70 Public Hospitals Child Health Clinics
• 2001 Assessments
• Represented 12,000
• 11 of 2 Yr Old Population
• 4,000 Chart Reviews

4
Process

• Assessment
• Chart Review Paper Tool and Computer Entry
• Coverage _at_ 2nd birthday and _at_ date of assessment
• 43133 and varicella
• Feedback Report
• Identify Barriers including MOV, Chart
  Organization
• Recommendations
• List Under-Immunized Children
• Feedback Meeting

5
Follow-up Actions

• Utilize the assessment
• Listed under-immunized children
• DOH promised to return in 2-3 months to reassess
  charts
• Actively involve the provider
• Provider needs to re-review incomplete charts
• Provider recalls / deactivates charts / utilizes
  the registry
• Provider initiates changes in the practice
• Incentive
• Re-calculate coverage rates for the cohort
• Incorporate changes into the practice

6
List of Under-Immunized Children to Recall
7
Outcome Increased coverage after recall 11 weeks
after assessment 18-35 month olds (N19
providers)
8
43133 Series coverage at assessment and after
recall 18 35 months of age, 19 sites, 2001
9
(No Transcript)
10
(No Transcript)
11
Reasons associated with missed opportunity to
vaccinate 43 Public Clinics and Private
Providers, 2001 (n748)
12
Barrier Accepting and Giving Excuses Interventio
n Turn the excuse into an explanation
13
Chickenpox is a mild disease.
But, the complications are NOT mild.
Protect the other family members.
If parent refuses, document chart.
14
Approaches to overcoming provider as barrier

• Heres a copy of our paper tool,
• please correct it if we are wrong.
• Heres a copy of the immunization schedule,
• lets review what is not clear.
• Pretend were your consultant.

15

• ASSESSMENT More than a single visit
• Passive process Active process
• Adversary Advocate

• For this cohort, significant improvement in
  coverage
• Initiate clinical administrative changes
• Establish precedent for continued improvement

16
Assessment Team Members IAP Cheryl Bodden Paula
Francis Crick Timothy Salters VFC Cassandra
Deas Daryl Perry Polly Hobbs Vasu
Nalipireddy