Sunday, August 26, 2012

Boosting Vaccination Rates

In 1992, the El Rio Center in Tucson Arizona in an effort to boost vaccination rates implemented a program to develop a comprehensive vaccine program especially geared to increasing pediatric immunizations among minorities and people living at the poverty level. A number of barriers exist due to transportation problems, scheduling conflicts, and/or financial constraints. In addition, many parents only have their child vaccinated when they take their child to a well- child visit.

Although great progress has been made over the past 20 years, overall immunization rates remain below established goals, and disparities still exist. For example, 86 percent of white children have received the diphtheria, tetanus, poliomyelitis, and pertussis vaccines as compared to 79 percent of black children and 80 percent of those children live below the poverty level.

The El Rio Health Center a Federally Qualified Health Center felt action was needed to increase the rate of vaccinations in their county. El Rio located in Tucson is the largest provider of healthcare for uninsured individuals and Medicaid enrollees in Pima County Arizona. The center serves 70,000 people and is the largest pediatric practice in Tucson. The program staff includes one full time medical assistant and El Rio employs 20 pediatricians and nurses across 6 locations.

Recognizing the organization’s low immunization rates, Andrew Arthur M.D, the Center’s Associate Medical Director approached administrators with a proposal to examine the barriers to achieving higher immunization rates.

To help the project get started, CDC and the American Academy of Pediatricians formed a community coalition to train physicians and community members on the benefits of increasing immunizations rates. At the same time multimedia educations materials for the general public were also developed.

The El Rio Health Center studied the issue and worked to address the problem. Since the initial problem was recognized, the Center has developed a comprehensive program to increase pediatric immunization rates. This is being accomplished by providing more training for pediatricians and nurses, developing an efficient computerized data system to track immunizations, providing electronic reminders for both parents and providers as needed for immunizations, and opening nurse-run immunization clinics in the center and community.

Technology has helped greatly to increase immunization rates. The data tracking system tracks each patient and includes information on the types of vaccines received and the specific dosages given. The registry assists with providing patient and provider reminders.

Record keeping for patient immunizations is now kept in the immunization module within the commercial EMR system used at the Center. The nursing staff routinely consults a patient’s immunization module when a child comes for a well-child visit and for the majority of other pediatric clinic appointment types.

However, there have been issues. In 2009 and 2010, El Rio implemented their EHR system but some problems occurred with immunization record-keeping as errors occurred when information was abstracted from the paper charts and inserted electronically into the EHR. To fix the problem, a program was put in place to correct the EHR immunization data.

Today, the program has more than tripled the Center’s immunization rates. During the first 3 to 5 years of the program, immunization rates for two year old children increased from 30 to go to 94 percent. By 2006, rates reached 97 percent. The program has maintained the high rates each year providing that adequate supplies of vaccines are available. As of 2012, all El Rio pediatric clinics have achieved immunization rate of 90 percent for the combo of the three vaccines for two year old patients who remain in the clinic’s care.

Source: AHRQ Health Care Innovations Exchange at