Improving immunization rates in private pediatric practices through physician leadership.

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Abstract
Objective To determine whether a physician-led quality improvement initiative can improve immunization rates in participating private practices. Design Surveys of private pediatric practices at 6-month intervals over an 18-month period. Setting Ten private pediatric practices in Norfolk and Virginia Beach, Va. Patients Children aged 9 to 30 months attending the private practices. Interventions Practice immunization rates were assessed and presented to practices on 4 occasions at 6-month intervals. A physician leader convened an immunization task force meeting following the first 3 assessments to review practice guidelines, examine data, and discuss practice changes. Main Outcome Measures Practice immunization rates for patients at age 24 months, with 3- and 12-month immunization rates as secondary outcomes. Results The mean practice immunization rate at age 24 months increased significantly (P<.05) from 50.9% at baseline to 69.7%. Rates also increased at age 3 months, from 75.5% to 88.9%, and at age 12 months, from 72.9% to 84.6%. The median age at administration of the fourth dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccine decreased (P<.05) from 17.6 to 16.8 months. Physicians also reported making additional changes, including improved record keeping and screening for immunizations at every visit. Conclusion A quality improvement initiative enabling physician leadership can improve preschool immunization practices and coverage levels in pediatric practices.