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Jeffrey S. Sinn, PhD; Ardythe L. Morrow, PhD; Albert B. Finch, MD

Arch Pediatr Adolesc Med. 1999;153:597-603.

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.

From the Department of Psychology, Winthrop University, Rock Hill, SC (Dr Sinn); Center for Pediatric Research, Eastern Virginia Medical School and Children's Hospital of the King's Daughters, (Drs Sinn and Morrow), and Department of Pediatrics, Children's Hospital of the King's Daughters and Its Physician Partners and Eastern Virginia Medical School (Dr Finch), Norfolk.

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