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Immunization Assessments: More Than a Single Visit

Immunization Assessments: More Than a Single Visit. NYC Department of Health Immunization Program. Assessments: More Than A Single Visit Karin Seastone Stern, DrPH,Director Clinic Assessments Denise Benkel, MD, MPH, Medical Specialist, Child Health Initiative

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Immunization Assessments: More Than a Single Visit

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  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@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 @ 2nd birthday and @ date of assessment • 4:3:1:3:3 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 (N=19 providers)

  8. 4:3:1:3:3 Series coverage at assessment and after recall 18 – 35 months of age, 19 sites, 2001

  9. Reasons associated with missed opportunity to vaccinate 43 Public Clinics and Private Providers, 2001 (n=748)

  10. Barrier: Accepting and Giving Excuses Intervention Turn the excuse into an explanation

  11. “Chickenpox is a mild disease.” “But, the complications are NOT mild.” Protect the other family members. If parent refuses, document chart.

  12. Approaches to overcoming provider as barrier Here’s a copy of our paper tool, please correct it if we are wrong. Here’s a copy of the immunization schedule, let’s review what is not clear. Pretend we’re your consultant.

  13. 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

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

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