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Charles W. LeBaron, MD; Mehran Massoudi, PhD, MPH; John Stevenson, MA; Hoang Dang, BS; Bridget Lyons, MPH

Arch Pediatr Adolesc Med. 2000;154:832-836.

Background  A large body of scientific and programmatic data has demonstrated that provider measurement and feedback raises immunization coverage. Starting in 1995, Congress required that all states measure childhood immunization coverage in all public clinics, and federal grant guidelines encourage private practice measurements.

Objectives  To determine state immunization measurement rates and examine risk factors for high rates.

Methods  Review of 1997 state reports, with correlation of measurement rates to birth cohort and provider numbers, public/private proportions, and vaccine distribution systems.

Results  Of the 9505 public clinics, 48% were measured; 4 states measured all clinics; 29 measured a majority. Measurement rates were highest for Health Department clinics (67%), lower for community/migrant health centers (39%), and lowest for other clinics (22%). Rates were highly correlated among categories of clinics (r>+0.308, P<.03), and the fewer the clinics, the higher the measurement rates (r = -0.351, P = .01), but other factors were not significant. Of the 41,378 private practices, 6% were measured; no state measured all its practices; 1 measured a majority. Private practice measurement rates were not correlated to public clinic measurement rates or other factors examined. Of the 50,883 total providers, 14% were measured; no state measured all providers; 2 measured a majority. A trend toward higher measurement rates was found in states with fewer providers (r = -0.266, P = .06).

Conclusions  Three years after the congressional mandate, only a minority of public clinics and very few private practices had their immunization coverage measured. Greater efforts will be needed to assure implementation of the intervention.

From the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga.

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Vaccination Coverage and Physician Distribution in the United States, 1997
LeBaron et al.
Pediatrics 2001;107:31e-31.
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