Effect of Missed Opportunities on Influenza Vaccination Rates Among Children With Asthma

Child Health Evaluation and Research Unit, Division of General Pediatrics, Ann Arbor, MI, USA.
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 5.73). 10/2006; 160(9):966-71. DOI: 10.1001/archpedi.160.9.966
Source: PubMed


To assess rates of influenza vaccination among children with asthma; document the frequency, timing, and patterns of missed opportunities to vaccinate during successive influenza seasons; and project potential influenza vaccination rates that could be achieved by reducing or eliminating missed opportunities.
Michigan Medicaid program during the 2001-2002 and 2002-2003 influenza seasons.
Retrospective cohort analysis of administrative claims.
We evaluated the claims of 4358 children aged 5 to 18 years with persistent asthma who were continuously enrolled in Medicaid.
Influenza vaccinations and missed opportunities assessed using procedure and diagnosis codes.
During the 2001-2002 season, 16.7% of children with asthma received an influenza vaccination; during 2002-2003, 21.8% received the vaccine (9.5% vaccinated in both seasons). However, 76.5% of children had at least 1 office visit during the 2001-2002 influenza season (75.3% during 2002-2003). Among children without influenza vaccination, 72.9% had at least 1 missed opportunity for vaccination during the 2001-2002 season and 69.3% during 2002-2003. The most common outcome was having at least 1 missed opportunity (39.6%) in each of 2 successive influenza seasons. Eliminating missed opportunities prior to the historical peak of influenza season would have increased the influenza vaccination rate among this population of children to 76%.
Missed opportunities for influenza vaccination among children with asthma are common and are often repeated from one influenza season to the next. Future studies should assess how interventions could be aimed at patients and health care professionals to improve awareness of the need for annual influenza vaccination.

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    • "Prior work with this population has demonstrated that provider encounters without immunizations are also common across a larger age span from birth to the age of two [8]. In addition, one other study linking immunization registry and medical record data systems has shown similar problems of special population children visiting providers but not receiving needed immunizations [9]. The number of encounters children had during the period when the fourth DTaP was due was only mildly associated with their receipt of the 4th DTaP. "
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    ABSTRACT: The successful completion of early childhood immunizations is a proxy for overall quality of early care. Immunization statuses are usually assessed by up-to-date (UTD) rates covering combined series of different immunizations. However, series UTD rates often only bear on which single immunization is missing, rather than the success of all immunizations. In the US, most series UTD rates are limited by missing fourth DTaP-containing immunizations (diphtheria/tetanus/pertussis) due at 15 to 18 months of age. Missing 4th DTaP immunizations are associated either with a lack of visits at 15 to 18 months of age, or to visits without immunizations. Typical immunization data however cannot distinguish between these two reasons. This study compared immunization records from the Oregon ALERT IIS with medical encounter records for two-year olds in the Oregon Health Plan. Among those with 3 valid DTaPs by 9 months of age, 31.6% failed to receive a timely 4th DTaP; of those without a 4th DTaP, 42.1% did not have any provider visits from 15 through 18 months of age, while 57.9% had at least one provider visit. Those with a 4th DTaP averaged 2.45 encounters, while those with encounters but without 4th DTaPs averaged 2.23 encounters.
    08/2012; 2013(51). DOI:10.5402/2013/351540
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    • "This approach could potentially serve as a standard for the evaluation of immunizations given to health plan participants and public populations in areas that have strong immunization information systems such as ALERT. A similar approach by Dombkowski et al. [21] has previously demonstrated the utility of combining registry and Medicaid data in Michigan for assessing missed opportunities to vaccinate asthmatics against influenza. The potential for missed opportunities to be misclassified as missed visits when conducting milestone analysis solely from immunization record data without all encounters should lead to caution in interpreting the balance of responsibility between parents and providers for children not being up-to-date. "
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    ABSTRACT: A challenge facing immunization registries is developing measures of childhood immunization coverage that contain more information for setting policy than present vaccine series up-to-date (UTD) rates. This study combined milestone analysis with provider encounter data to determine when children either do not receive indicated immunizations during medical encounters or fail to visit providers. Milestone analysis measures immunization status at key times between birth and age 2, when recommended immunizations first become late. The immunization status of a large population of children in the Oregon ALERT immunization registry and in the Oregon Health Plan was tracked across milestone ages. Findings indicate that the majority of children went back and forth with regard to having complete age-appropriate immunizations over time. We also found that immunization UTD rates when used alone are biased towards relating non-UTD status to a lack of visits to providers, instead of to provider visits on which recommended immunizations are not given.
    BioMed Research International 05/2010; 2010:916525. DOI:10.1155/2010/916525 · 2.71 Impact Factor
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