Gerry Fairbrother

AcademyHealth, Washington, Washington, D.C., United States

Are you Gerry Fairbrother?

Claim your profile

Publications (63)139.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: School-based health centers (SBHCs) are located conveniently on school campuses, providing accessible and youth-friendly care to at-risk adolescents with otherwise limited access to care. We examined aspects of quality of care and health engagement using data from seven SBHCs in Colorado and New Mexico. High school SBHC-users completed the previously-validated Youth Engagement with Health Services (YEHS!) survey on an iPad as part of a federally-funded SBHC quality improvement project. The majority of the 221 respondents were Hispanic (77%) and female (78%); median age was 16 years. The majority reported low/medium socioeconomic status and over a quarter (29%) reported being uninsured. Three-quarters reported sexual activity and 38% reported being at-risk for depression. In the past year, respondents had accessed SBHC services including: behavioral health care (25% of respondents), well-child checks (45%), reproductive health care (38%), and acute care (34%). Over 30% of respondents received all of their care at SBHCs. Almost three-quarters (71%) of respondents reported receiving all or most of their care at the SBHC (usual SBHC-users) and 29% were non-usual SBHC-users. In comparison with non-usual SBHC-users, usual SBHC-users reported a better Experience of Care score (p<.01) and a higher Health Self-Efficacy score (p<.01) indicating that SBHCs provide positive health care experiences and promote active health engagement for youth. SBHCs offer an ideal healthcare delivery option for adolescents and represent an important part of the public health care system. Adolescents with access to SBHCs receive youth-friendly primary and behavioral health services in an environment that fosters actively engaged healthcare consumers.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. We sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. We found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions. This analysis, conducted through the Medicaid Medical Directors Learning Network, allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement.
    Health affairs (Project Hope). 08/2014; 33(8):1337-44.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Cincinnati, Ohio, metropolitan area was one of seventeen US communities to participate in the federal Beacon Community Cooperative Agreement Program to demonstrate how health information technology (IT) could be used to improve health care. Given $13.7 million to spend in thirty-one months, the Cincinnati project involved hundreds of physicians, eighty-seven primary care practices, eighteen major hospital partners, and seven federally qualified health centers and community health centers. The thrust of the program was to build a shared health IT infrastructure to support quality improvement through data exchange, registries, and alerts that notified primary care practices when a patient visited an emergency department or was admitted to a hospital. A special focus of this program was on applying these tools to adult patients with diabetes and pediatric patients with asthma. Despite some setbacks and delays, the basic technology infrastructure was built, the alert system was implemented, nineteen practices focusing on diabetes improvement were recognized as patient-centered medical homes, and many participants agreed that the program had helped transform care. However, the experience also demonstrated that the ability to transfer data was limited in electronic health record systems; that considerable effort was required to adapt technology to support quality improvement; and that the ambitious agenda required more time for planning, training, and implementation than originally thought.
    Health Affairs 05/2014; 33(5):871-7. · 4.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to create and validate a survey instrument designed to measure Youth Engagement with Health Services (YEHS!). A 61-item YEHS! survey was created through a multistaged process, which included literature review, subject matter expert opinion, review of existing validated measures, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight school-based health centers in Colorado and New Mexico. We conducted psychometric analyses and examined correlations between the youth health engagement scales and measures of quality of care. We created scales to measure two domains of youth health engagement: health access literacy and health self-efficacy. The youth health engagement scales demonstrated strong reliability (Cronbach's α .76 and .82) and construct validity (mean factor loading .71 and .76). Youth health engagement scores predicted higher experiences of care scores (p < .001) and receipt of more anticipatory guidance (p < .01). This study supports the YEHS! as a valid and reliable measure of youth health engagement among adolescents using school-based health centers. We demonstrate an association between youth health engagement and two quality of care measures. Additional testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations.
    Journal of Adolescent Health 04/2014; · 2.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The purpose of this study was to create and validate a survey instrument designed to measure Youth Engagement with Health Services (YEHS!). Methods A 61-item YEHS! survey was created through a multistaged process, which included literature review, subject matter expert opinion, review of existing validated measures, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight school-based health centers in Colorado and New Mexico. We conducted psychometric analyses and examined correlations between the youth health engagement scales and measures of quality of care. Results We created scales to measure two domains of youth health engagement: health access literacy and health self-efficacy. The youth health engagement scales demonstrated strong reliability (Cronbach's α .76 and .82) and construct validity (mean factor loading .71 and .76). Youth health engagement scores predicted higher experiences of care scores (p < .001) and receipt of more anticipatory guidance (p < .01). Conclusions This study supports the YEHS! as a valid and reliable measure of youth health engagement among adolescents using school-based health centers. We demonstrate an association between youth health engagement and two quality of care measures. Additional testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations.
    Journal of Adolescent Health. 01/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The United States has experienced two shortages of heptavalent pneumococcal conjugate vaccine (PCV7). National guidelines called for deferring the third and fourth PCV7 doses from healthy children during these shortages. However, recommendations were not the same during the first and second shortages, and recommendations changed over time during each of the shortages as shortages worsened. OBJECTIVES: To measure PCV7 immunizing behavior for healthy children during shortage and non-shortage periods and assess the accuracy of the physicians' reported immunizing behavior when compared to their actual immunizing behavior. METHODS: We reviewed medical records in 14 randomly selected practices to measure actual immunizing behavior during shortage and non-shortage periods. We surveyed pediatricians in the Greater Cincinnati area to ascertain reported immunizing behavior. Actual and reported immunizing behaviors were compared. RESULTS: 2888 medical records were reviewed; surveys were obtained from 51 pediatricians (65% response rate). During periods of non-shortage, 74% of healthy children received their first two doses of PCV7 on time, whereas during periods of shortage, only 66% of healthy children received their first two doses of PCV7 on time. Compared with measured immunizing behavior from chart reviews, 54-76% of the pediatricians overestimated their compliance with guidelines to defer the fourth PCV7 dose while only 5-20% underestimated their compliance. CONCLUSIONS: Physicians often overestimated the percentage of children whose vaccine doses they deferred during vaccine shortages. Despite these findings, physicians were able to maintain high coverage with the first two PCV7 doses among healthy children.
    Vaccine 03/2013; · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE:To understand factors associated with pediatric inpatient safety events, we test 2 hypotheses: (1) scarce resources (as measured by Medicaid burden) in safety-net hospitals relative to non-safety-net hospitals result in higher rates of safety events; and (2) higher levels of severity and more chronic conditions in patient populations lead to higher rates of safety events within hospital category and in children's hospitals in comparison with non-children's hospitals.METHODS:All nonnewborn pediatric hospital discharge records, which met criteria for potentially experiencing at least 1 pediatric quality indicator (PDI) event (using Agency for Healthcare Research and Quality's 2009 Nationwide Inpatient Sample and PDI) and weighted to represent national level estimates, were analyzed for patterns of PDI events within and across hospital categories by using bivariate comparisons and multivariable logit models with robust SEs. The outcome measure "ANY PDI" captures the number of pediatric discharges at the hospital level with 1 or more PDI event.RESULTS:High Medicaid burden does not seem to be a factor in the likelihood of ANY PDI. Severity of illness (adjusted odds ratio high relative to low, 15.12) and presence of chronic conditions (adjusted odds ratio 1 relative to 0, 1.78; relative to 2 or more, 3.38) are the strongest predictors of ANY PDI events.CONCLUSIONS:Our findings suggest that the patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing hospitals. Thus, problems of quality may not be systemic across hospital categories.
    PEDIATRICS 01/2013; · 4.47 Impact Factor
  • Academic pediatrics 01/2013; 13(5):387-9.
  • Lisa A. Simpson, Gerry Fairbrother
    Academic Pediatrics. 01/2013; 13(6):S16–S20.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. Using a population-based surveillance network, we evaluated a representative group of children aged <5 years with laboratory-confirmed, medically attended influenza during the 2003-2004 season. Children hospitalized or seen in emergency department (ED) or outpatient settings in surveillance counties with laboratory-confirmed influenza were identified and data were collected from medical records, accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination.
    Vaccine 04/2012; 30(28):4175-81. · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the association between Medicaid-induced financial stress of a hospital and the probability of an adverse medical event for a pediatric discharge. Secondary data from the Nationwide Inpatient Sample, Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, and the American Hospital Association's Annual Survey of Hospitals. Study examines 985,896 pediatric discharges (children age 0-17), from 1,050 community hospitals in 26 states (representing 63 percent of the U.S. Medicaid population) between 2005 and 2007. We estimate the probability of an adverse event, controlling for patient, hospital, and state characteristics, using an aggregated, composite measure to overcome rarity of individual events. Children in hospitals with relatively high proportions of pediatric discharges that are more reliant on Medicaid reimbursement are more likely than children in other hospitals (odds ratio = 1.62) to experience an adverse event. Medicaid pediatric inpatients are more likely than privately insured patients (odds ratio = 1.10) to experience an adverse event. Hospital reliance on comparatively low Medicaid reimbursement may contribute to the problem of adverse medical events for hospitalized children. Policies to reduce adverse events should account for differences in underlying, contributing factors of these events.
    Health Services Research 02/2012; 47(4):1621-41. · 2.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite frequent use of self-reported information to determine pediatric influenza vaccination coverage, little data are available on the validity of parental reporting of their child's influenza vaccination status and on factors affecting its accuracy. We compared parent reported influenza vaccination of children to documented reports of vaccination collected from medical records (the criterion standard) among children aged 6-59 months who presented to selected hospitals, emergency departments, and clinics in three U.S. counties with acute respiratory illness during three influenza seasons (November through May of 2004-2007). Demographic and epidemiologic data were collected from chart reviews and parental surveys. Among 3072 children aged 6-59 months, 47.5% were reported by the parent to have received influenza vaccine and 39.5% of children had medical record verification of influenza vaccination. Sensitivity and specificity of parental reporting was 92.1% and 82.3%, respectively, when compared to the immunization record. However, 17.7% of children whose parents reported vaccination had no influenza vaccination documented in their medical records, and this proportion was even higher at 28.6%, among children with an underlying high-risk medical condition. Greater reporting accuracy was associated with younger age of child (6-23 months vs. 24-59 months), white non-Hispanic race/ethnicity, having health insurance, and having a mother with a college education. Our findings indicate that although parental report of influenza vaccination is fairly reliable (∼76-96%), over reporting by parents often occurs and immunization record review remains the preferable method for determining vaccination status in children.
    Vaccine 11/2011; 29(51):9488-92. · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the impact of missed opportunities on influenza vaccination coverage among 6- through 23-month-old children who sought medical care during the 2004-2005 influenza season. Retrospective cohort study. Fifty-two primary care practice sites located in Rochester, New York, Nashville, Tennessee, and Cincinnati, Ohio. Children 6 through 23 months of age. METHODS/OUTCOME MEASURE: Charts were reviewed and data collected on influenza vaccinations, type of health care visit (well child or other), and presence of illness symptoms. Missed opportunity was defined as a practice visit by an eligible child during influenza season, when vaccine was available, but during which the child did not receive an influenza vaccination. Vaccine was assumed to be available between the first and last dates influenza vaccination was recorded at that practice. Each child was classified as fully vaccinated, partially vaccinated, or unvaccinated. Data were analyzed for 1724 children, 6 through 23 months of age. Most children (62.0%) had at least 1 missed opportunity during this period. Among children with any missed opportunities, 12.8% were fully and 29.8% were partially vaccinated. Overall, 33.6% of the missed opportunities occurred during well child visits and 66.4% during other types of visits; 75% occurred when no other vaccines were given. Eliminating all missed opportunities would have increased full vaccination coverage from 30.3% to 49.9%. Missed opportunities for influenza vaccination are frequent. Reducing missed opportunities could significantly increase influenza vaccination rates and should be a goal in each practice.
    Journal of public health management and practice: JPHMP 11/2011; 17(6):560-4. · 1.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the effectiveness of influenza vaccine against medical care visits for laboratory-confirmed influenza in young children we conducted a matched case-control study in children with acute respiratory illness or fever from 2005-2007. Influenza vaccine effectiveness (VE) was calculated using cases with laboratory-confirmed influenza and controls who tested negative for influenza. The effectiveness of influenza vaccine in fully vaccinated children 6-59 months of age was 56% (95% CI: 25%-74%); a significant VE was not found for partial vaccination.
    Vaccine 09/2011; 29(48):9005-11. · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the vaccine effectiveness (VE) of complete and partial vaccination with the pentavalent rotavirus vaccine (RV5) in the prevention of rotavirus acute gastroenteritis (AGE) hospitalizations and emergency department visits during the first 3 rotavirus seasons after vaccine introduction. Active, prospective population-based surveillance for AGE and acute respiratory infection (ARIs) in inpatient and emergency department settings provided subjects for a case-control evaluation of VE in 3 US counties from January 2006 through June 2009. Children with laboratory-confirmed rotavirus AGE (cases) were matched according to date of birth and onset of illness to 2 sets of controls: children with rotavirus-negative AGE and children with ARI. The main outcome measure was VE with complete (3 doses) or partial (1 or 2 doses) RV5 vaccination. Of age-eligible children enrolled, 18% of cases, 54% of AGE controls, and 54% of ARI controls received ≥1 dose of RV5. The VE of RV5 for 1, 2, and 3 doses against all rotavirus genotypes with the use of rotavirus-negative AGE controls was 74% (95% confidence interval [CI]: 37%-90%), 88% (95% CI: 66%-96%), and 87% (95% CI: 71%-94%), respectively, and with the use of ARI controls was 73% (95% CI: 43%-88%), 88% (95% CI: 68%-95%), and 85% (95% CI: 72%-91%), respectively. The overall VE estimates were comparable during the first and second years of life and against AGE caused by different rotavirus strains. RV5 was highly effective in preventing severe rotavirus disease, even after a partial series, with protection persisting throughout the second year of life.
    PEDIATRICS 08/2011; 128(2):e267-75. · 4.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Children's Health Insurance Program Reauthorization Act (CHIPRA) requires states to measure and report on coverage stability in Medicaid and the Children's Health Insurance Program (CHIP). States generally have not done this in the past. This study proposes strategies for both measuring stability and targeting policies to improve retention of Medicaid coverage, using Ohio as an example. A cohort of newly enrolled children was constructed for the 1-year time period between July 2007 and June 2008 and followed for 18 months. Hazard ratios were estimated after 18 months to predict the likelihood of maintaining continuous enrollment in Medicaid, adjusting for income eligibility group, age, race, gender, county type, and change in unemployment. Children dropping from the program at the renewal period (12-16 months) were followed for 12 months to determine their rate of return. Approximately 26% of children aged <1 year and 35% of children aged 1 to 16 years dropped from Medicaid by 18 months, with the steepest drop occurring after 12 months, the point of renewal. Likelihood of dropping was associated with the higher income eligibility groups, older children, and Hispanic ethnicity. Approximately 40% of children who were dropped at renewal re-enrolled within 12 months. Children in the lowest income group returned sooner and in higher proportions than other children. A substantial number of children lose Medicaid coverage only to re-enroll within a short time. Income eligibility group appears to be a strong indicator of stability. Effective monitoring of coverage stability is important for developing policies to increase retention of eligible children.
    Academic pediatrics 01/2011; 11(4):318-25.
  • Source
    Gerry Fairbrother, Lisa A Simpson
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND PURPOSE: The coming years could be a watershed period for children and health care as the nation implements the most significant federal health care legislation in 50 years: the Accountable Care Act (ACA). A year earlier, the American Recovery and Reinvestment Act (ARRA) set up a framework and road map for the eventual universal adoption of health information technology in its Health Information Technology for Economic and Clinical Health (HITECH) provisions, and the Children's Health Insurance Program Reauthorization Act (CHIPRA) legislation articulated a new and compelling vision for quality measurement in child health services. Each of these landmark advances in federal health policy contains relevant provisions for the measurement and improvement of the performance of the health system. Less clear is the extent to which the child specific framework articulated in CHIPRA will be preserved and built upon. Here, we set forth recommendations for ensuring that measurement and reporting efforts under CHIPRA, ARRA, and ACA are aligned for children. POLICY THEMES AND RECOMMENDATIONS: Our findings around problems and recommendations are grouped into 2 broad areas: those that deal with helping states report and use current measures, and those that deal with expanding the current measures. Recommendations include 5 aimed at focusing efforts on measure reporting and use: 1) help states build a measurement infrastructure; 2) provide specific technical assistance and support to states on how to collect, report, and use measures; 3) establish a national office for quality monitoring; 4) make available nationally data from states; and 5) ensure specific focus on child health in HITECH initiatives. Recommendations also include 3 aimed at extending what is being measured: 1) continue emphasis on insurance stability; 2) ensure that disparities can be measured and monitored; and 3) build measures that focus on system accountability and outcomes. CONCLUSIONS: National health care reform provides the opportunity to extend coverage and dramatically restructure systems of care. It will be important to ensure that focus on health care quality for children be maintained and that the advances made under CHIPRA reinforce and are not diluted or overtaken by broader reform efforts.
    Academic pediatrics 01/2011; 11(3 Suppl):S77-84.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Practical and objective instruments to assess pediatric Crohn's disease (CD) activity are required for observational research and quality improvement. The objectives were: 1) to determine the feasibility of completing the Pediatric Crohn's Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI); and 2) to create a Short PCDAI by retaining and reweighting the most practical and informative components. Physicians in the ImproveCareNow Collaborative for pediatric inflammatory bowel disease (IBD) were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each patient encounter. We assessed the feasibility of the PCDAI, the APCDAI, and the individual index components by determining the proportion of visits in which data were recorded. We created a short index by retaining and reweighting components of the PCDAI completed in ≥80% of visits. The feasibility of the Short PCDAI and its ability to discriminate between PGA categories were evaluated using descriptive statistics. This study population included 1355 subjects with CD (6373 visits). The PCDAI and APCDAI were complete in 16.7% and 44.1% of visits, respectively. A Short PCDAI, including general well-being, abdominal pain, stools, weight, abdominal exam, and extraintestinal manifestations were completed in 66.5% of visits. The correlation between the Short PCDAI and PGA was similar to that of the PCDAI (r = 0.60, P < 0.001 versus 0.61, P < 0.001). The Short PCDAI is a practical and valid tool to measure pediatric CD activity. Its use should facilitate quality improvement and observational research.
    Inflammatory Bowel Diseases 01/2011; 17(1):112-7. · 5.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the trend in Clostridium difficile infection (CDI) among hospitalized children in the United States and to evaluate the severity of and risk factors associated with these cases of CDI. A retrospective cohort study using the triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 1997, 2000, 2003, and 2006. Hospitalized children in the United States. A nationally weighted number of patients (10 474 454) discharged from the hospital, 21 274 of whom had CDI. Discharge diagnosis of CDI. Trend in cases of CDI; effect and severity were measured by length of hospital stay, hospitalization charges, colectomy rate, and death rate. There was an increasing trend in cases of CDI, from 3565 cases in 1997 to 7779 cases in 2006 (P < .001). Patients with CDI had an increased risk of death (adjusted odds ratio [OR], 1.20; 95% confidence interval [95% CI], 1.01-1.43), colectomy (adjusted OR, 1.36; 95% CI, 1.04-1.79), a longer length of hospital stay (adjusted OR, 4.34; 95% CI, 3.97-4.83), and higher hospitalization charges (adjusted OR, 2.12; 95% CI, 1.98-2.26). There was no trend in death, colectomy, length of hospital stay, or hospitalization charges during the 4 time periods (ie, 1997, 2000, 2003, and 2006). The risk of comorbid diagnoses associated with CDI included inflammatory bowel disease, with an OR of 11.42 (95% CI, 10.16-12.83), and other comorbid diagnoses associated with immunosuppression or antibiotic administration. There is an increasing trend in CDI among hospitalized children, and this disease is having a significant effect on these children. In contrast to adults, there is no increasing trend in the severity of CDI in children. Children with medical conditions (including inflammatory bowel disease and immunosuppression) or conditions requiring antibiotic administration are at high risk of CDI. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Air Force, Department of Defense, nor the U.S. government. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that ―copyright protection under this title is not available for any work of the United States Government.‖ Title 17 U.S.C. 101 defines a United States government work as ―a work prepared by a military service member or employee of the United States government as part of that person's official duties.
    JAMA Pediatrics 01/2011; 165(5):451-7. · 4.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004-2005 influenza season, the first season for the universal influenza vaccination recommendation for all children who are aged 6 to 23 months. Clinical and demographic data from randomly selected children who were aged 6 to 23 months were obtained by chart review from a community-based cohort study in 3 US counties. The proportion of children who were vaccinated by April 5, 2005, in each practice was obtained. For assessment of practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics that predicted complete influenza vaccination were determined by using multinomial logistic regression. Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children who were aged 6 to 23 months and were studied, 27% were completely vaccinated. The proportion of children who were completely vaccinated varied widely among practices (0%-71%). Most (87%) practices implemented ≥1 vaccination strategy. Complete influenza vaccination was associated with 3 practice characteristics: suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; with child characteristics of younger age, existing high-risk conditions, ≥6 well visits to the practice by 3 years of age, and any practice visit from October through January. Modifiable factors that were associated with increased influenza vaccination coverage included October to January practice visits and evening/weekend vaccine clinics.
    PEDIATRICS 10/2010; 126(4):665-73. · 4.47 Impact Factor

Publication Stats

808 Citations
139.77 Total Impact Points


  • 2012–2013
    • AcademyHealth
      Washington, Washington, D.C., United States
  • 2006–2013
    • University of Cincinnati
      Cincinnati, Ohio, United States
    • University of Oklahoma Health Sciences Center
      Oklahoma City, Oklahoma, United States
  • 2005–2013
    • Cincinnati Children's Hospital Medical Center
      • • James M. Anderson Center for Health Systems Excellence
      • • Department of Pediatrics
      Cincinnati, OH, United States
  • 2009–2012
    • Centers for Disease Control and Prevention
      • • National Center for Immunization and Respiratory Diseases
      • • Division of Viral Diseases
      Atlanta, Michigan, United States
  • 2008
    • University of Rochester
      Rochester, New York, United States
  • 2007–2008
    • Oregon Health and Science University
      • Department of Family Medicine
      Portland, OR, United States
  • 2003–2005
    • New York Academy of Medicine
      New York City, New York, United States