Article Figures & Data
Figures
- Figure 1.
Influenza vaccination rates of children aged 2 to 17 years with chronic medical conditions.
Tables
Intervention Year 1 Intervention Year 2 Site Site Characteristics 1 2 3 4 5 1 2 3 4 5 Note: Interventions are categorized according to the scheme of the Task Force on Community Preventive Services. PR = pediatric residency; FB = faith-based; FM = family medicine residency; EVR = electronic vaccine registry; EMR = electronic medical record; manual = paper charts; ✓ = used at site; – = not used at site. * Changed from dictated notes entered into EMR to direct physician entry into new EMR. † Saturday. ‡ Weekdays during office hours. § Only for children who had previously received an influenza vaccine. Site Type PR FB FB FM FM PR FB FB FM FM Number of offices 5 2 1 1 1 5 2 1 1 1 Immunization tracking EVR EMR Manual EMR Manual EVR EMR Manual New New Strategy EMR* EMR Interventions to increase demand for vaccines Posters in waiting and examination rooms ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Letter or flier mailed to parent ✓ ✓ ✓ ✓ ✓ ✓ ✓ – ✓ – Telephone calls to parent ✓ – – – ✓ ✓ – – – – Flier handed out at registration during influenza season – – – – – – – – – ✓ Interventions to enhance access to vaccination services Walk-in flu shots during office hours ✓ ✓ ✓ – – ✓ ✓ ✓ – – Special event flu shot clinics † – ‡ – – † – ‡ – – Physician or system-based interventions Clinician education ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Standing orders for nurses to vaccinate ✓ ✓ ✓ ✓ – ✓ ✓ ✓ ✓ – Physician educational reminder e-mails ✓ ✓ ✓ ✓ ✓ – – – – – Chart reminders: printed or hand-written or EMR pop-up screen or flag ✓ ✓ – – – – ✓ – § – Total number of interventions 9 7 7 5 5 7 6 5 4 3 Change in vaccination rate over 2 years (%) – – – – – 8 11.3 15.6 28 13.3 - Table 2.
Characteristics of Children Aged 2 to 17 Years at Intervention Sites by Study Year
Variable Preintervention (n = 2,438) No. (%) Intervention Year 1 (n = 2,935) No. (%) Intervention Year 2 (n = 3,311) No. (%) P Value* * Using χ2 test. Sex .320 Male 1,334 (54.7) 1,664 (56.7) 1,844 (55.7) Female 1,000 (41.0) 1,171 (39.9) 1,352 (40.8) Unknown 104 (4.3) 100 (3.4) 115 (3.5) Race <.001 Black 1,107 (45.4) 1,224 (41.7) 1,227 (37.1) White/other 312 (12.8) 320 (10.9) 385 (11.6) Unknown 1,019 (41.8) 1,391 (47.4) 1,699 (51.3) Insurance type <.001 Private 305 (12.5) 299 (10.2) 430 (13.0) Medicaid 1,177 (48.3) 1,626 (55.4) 1,863 (56.3) Self-pay 59 (2.4) 100 (3.4) 100 (3.0) Not reported 897 (36.8) 910 (31.0) 918 (27.7) Age, years <.001 2–6 774 (31.7) 1,126 (38.4) 1,121 (33.9) 7–12 1,038 (42.6) 937 (31.9) 1,258 (38.0) 13–17 626 (25.7) 872 (29.7) 932 (28.1) - Table 3.
Proportion of Children Aged 2 to 17 Years at Intervention Sites Vaccinated Against Influenza by Intervention Year and by Sex, Race, and Age
Vaccination Rate (%) Variable Preintervention (n = 2,438) Intervention Year 1 (n = 2,935) Intervention Year 2 (n = 3,311) P Value * Analysis of variance for the binary outcome. Preintervention year = 2001–2002; intervention year 1 = October 2002–February 2003; intervention year 2 = October 2003–February 2004. Sex Male 10.7 12.0 18.4 <.001 Female 11.4 14.9 18.8 <.001 Unknown 14.6 10.0 22.6 .015 Race Black 9.9 12.1 19.6 <.001 White/other 17.9 18.1 25.7 .001 Unknown 10.5 11.1 16.5 <.001 Age, years 2–6 14.3 14.0 19.0 .002 7–12 10.4 12.7 20.7 <.001 13–17 8.6 9.5 15.8 <.001 Type of practice Pediatric residency 11.2 12.5 18.1 <.001 Family medicine residencies 4.2 8.1 27.0 .002 Faith-based health centers 16.7 18.2 31.0 .020 Total 10.4 13.1 18.7 <.001 - Table 4.
Determinants of Vaccination by Logistic Regression Among Children Aged 2 to 17 Years in 2001–2004 (n = 6,837)
Variable Odds Ratio (95% CI) P Value CI = confidence interval. Age (reference = 2–6 years) 7–12 years 0.9 (0.8 – 1.1) .418 13–17 years 0.5 (0.4 – 0.6) <.001 Race (reference = black) White/other 1.5 (1.2 – 1.8) <.001 Unknown 0.8 (0.7 – 0.9) <.001 Sex (reference = female) Male 0.9 (0.8 – 0.99) .047 Unknown 1.3 (0.9 – 1.8) .130 Insurance type (reference = Medicaid) Private 1.4 (1.1 – 1.6) .002 Self-pay 0.8 (0.5 – 1.1) .196 Not reported 1.0 (0.8 – 1.2) .977 Year (reference = preintervention) Intervention year 1 1.9 (1.6 – 2.2) <.001 Intervention year 2 2.8 (2.3 – 3.4) <.001 Type of practice (reference = family medicine residency) Pediatric residency 1.7 (1.1 – 2.5) .013 Faith-based health centers 3.0 (1.9 – 5.0) <.001
The Article in Brief
Improving Influenza Vaccination of High-Risk Inner-City Children Over 2 Intervention Years
By Richard K. Zimmerman, MD, and colleagues
Background Rates of influenza (flu) vaccination among children with high-risk conditions, such as asthma, are low. This study set out to determine whether selecting from a menu of specially designed strategies (such as flu vaccines on a walk-in basis or reminder e-mails for clinicians) would help inner-city health centers raise vaccination rates among high-risk children.
What This Study Found Over a 2-year period, a menu of tailored strategies results in a modest rise in flu vaccination rates for high-risk children aged 2 to 17 years. When offered a menu of options, inner-city health centers use a variety of strategies based on their specific needs and their office and patient cultures.
Implications
- In this study, immunization rates were lower in adolescents. Strategies particularly targeted to older children, such as after-school immunization clinics or providing flu vaccination when asthma medications are refilled, may be helpful.
- Immunization rates may be further improved by refining the strategies offered and focusing on the culture of individual medical practices.
