ASSESSING IMMUNIZATION COVERAGE IN PRIVATE PRACTICE: ALL PROVIDERS SHOULD ASSESS COVERAGE
A review of the literature strongly suggests that providers who administer vaccines will benefit from monitoring their performance through assessment, including physicians in private practice. For those who work in public clinics, all states now require clinics to measure immunization coverage of 2-year-old children and the Advisory Committee on Immunization Practices recommends routine assessment by all providers. In addition, managed care organizations have begun to use immunization assessment as an indicator of the quality of health care services. Report cards or the Health Plan Employer Data and Information Set (HEDIS) measurements are becoming more important to MCOs. HEDIS was developed by the National Committee for Quality Assurance, an accrediting organization for MCOs. Many physicians in private practice do participate in one or more MCOs through an independent practice association. As we change to a more managed health care delivery system, documentation of the quality of services and care will become common. While providers who work directly as an employee of a “staff model” MCO similar to Kaiser Permanente or Prudential will be required to measure quality of services, all other providers receiving capitation or other forms of payment from MCOs will soon feel the pressure to assist MCOs in documenting the provision of quality care.
Another reason is that for interested or enrolled providers in the Vaccines for Children program, assessment can provide required information for reporting. Vaccines for Children is a new program enacted by Congress in 1993 to provide free vaccine to children who are eligible for Medicaid, American Indian or Alaskan Native, or uninsured or underin-sured for immunization if vaccine is administered in a federally qualified health center. In addition, immunization coverage can be used to summarize the patient profile, which is used to determine the type and amount of vaccines needed by the practice. In some states, coverage estimates can fulfill the reporting requirements for vaccine usage for providers in all practice settings, including private physicians.
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TOOLS AND TECHNIQUES FOR ASSESSMENT
Immunization coverage can be assessed manually or automatically using a computer. One manual technique is a self-assessment questionaire. A sample of 30 children aged 2 years or younger who visit a practice are selected for review. Selected children are the first 30 children seen in a day or over several days. Three forms are used to assist with screening for immunization status of children, analyzing data, and identifying the next step for improving immunization coverage of patients. In particular, these forms summarize the number of children up-to-date for immunization, reasons why patients are not immunized, the immunization rate, and the number immunized by age and type of visit. From these findings, conclusions and additional steps to implement are generated.
The other technique is the use of a CDC-devel-oped software package, the “Clinic/Provider Assessment Software Application (CASA)” for use in a microcomputer. It is a user-friendly program that has already assessed immunization coverage in public clinics in the 50 states. The medical records of a sample of children aged 19 to 35 months or all children are selected depending in the number of patients by age in the practice. Demographic information on patients and the vaccination dates are entered into the program. CASA then summarizes the data and generates reports on the overall immunization level, age-specific levels, and some reasons for suboptimal coverage, including missed opportunities, late starts, and drop out rates. It also prints a list of the names of children who had a missed opportunity for immunization or dropped out of the practice so that they can be recalled for immunization or reminded that they missed a visit.
Both the self-assessment tool and CASA can be obtained at no cost from the National Immunization Program at the CDC by calling 800-232-2522 or via the Internet.
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CONCLUSION
Assessing immunization coverage of patients in private practice is key to optimally delivering quality immunization services. In addition, it serves to document for the private practice success in providing what is considered the standard of care, which is needed in this era of report cards for health care services. There are techniques and tools available at no cost to fit the available resources of a private provider. Assessment is a wise investment in the health of children and adults.