Analyzing

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Analyzing Missed Opportunities to Vaccinate
New York City Department of Health Immunization
Program
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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
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Barrier Missed opportunities to vaccine
Process AFIX Document Coverage
Outcome /CDC Goal Increase Coverage
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Process Missed Opportunity to Vaccinate Cohort
of 24-35 month olds

• Review last visit to practice
• Type visit
• Vaccines administered
• One observation per visit
• Analysis program calculates
• Children due for vaccines
• Children eligible and no valid
  contraindication
• Opportunity taken or opportunity missed

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MOV Analysis is Provider-Specific

• Number / percent of children with MOV
• Identify reasons associated with MOV
• one reason per childs last visit
• Specify number of doses missed
• Indicate what coverage could have been if
  opportunity was taken
• List the charts with MOV

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Assure providerMOVs do not include valid
contraindications

• Few valid contraindications
• Medical Valid Contraindications
• T gt101
• Moderate Illness
• Immuno-Compromised (live vaccines)
• Additional reasons / specific examples
• Urgent or emergent visit
• Hydration or ventilation therapy
• Documented refusal

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Reasons Associated with Missed Opportunity to
Vaccinate 43 Public Clinics and Private
Providers, 2001 (n748)
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Barrier Mis-assessing Vaccine Status as Complete

• UTD

INTERVENTION Inform provider and parent Whats
due next When
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Barrier Not Adhering to Recommended
Schedule /or Appropriate Interval

Intervention Clarify the schedule Intervention
Repeat the invalid doses DTaP Interval 6 months
between 3rd 4th dose Administer 4th dose at
12-15 months HIB Trihibit valid only for 4th
or booster dose MMR/Varicella Interval 1
month between live vaccines or give
vaccines simultaneously on or after
1st birthday (state law)
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BARRIER Multiple Flow Sheets INTERVENTION Use a
single flow sheet
Document Each Vaccine on a single Flow
Sheet Keep Computerized records accurate
_at_
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Attachment II List of children with MOVs
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Discuss Impact of MOVs At Last Visit50 children
due eligible44 children (88) had MOV
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MOVs by Type of Visit (n44)
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Discuss impactWhat coverage could have been
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• Using MOV Analysis
• To Overcome Barriers to Under-Immunization
• Identify and discuss reasons why MOVs occurred
• Develop practice specific interventions

• PROVIDER RESPONSE
• Understand why coverage was low
• Initiate medical and administrative changes
• Improve immunization coverage

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