An organizational strategy to improve adolescent measles-mumps-rubella vaccination in a low socioeconomic population. A method to reduce missed opportunities
P. G. Harper and D. M. Murray
Department of Family Medicine, St Paul (Minn) Ramsey Medical Center.
OBJECTIVE: To determine whether a clinical organization strategy can
improve measles-mumps-rubella vaccination rates in adolescents by reducing
missed opportunities. DESIGN: Nonequivalent control group design with a
treatment clinic and a comparison clinic. Measurements were made for 8
months before intervention and for 9 months after intervention. SETTING:
Two urban family practice clinics serving a low socioeconomic population.
POPULATION: All clinic visits by adolescents aged 11 to 18 years.
INTERVENTION: A clinic organizational strategy that systematically
identified and vaccinated adolescents seen in the clinic for any reason.
MAIN OUTCOME MEASURES: Two vaccination indexes were measured monthly at
each clinic: the percentage of eligible visits at which
measles-mumps-rubella vaccination was given and the percentage of visits
that were up to date, with adolescents having received the
measles-mumps-rubella vaccine at that visit or at a previous visit.
RESULTS: The intervention resulted in a significant increase at the
treatment clinic in the mean percentage of vaccinations given (from 7.8% to
17.4%) (Student's t = 3.02; P = .0087) and the mean percentage of
up-to-date visits (from 17.2% to 38.6%) (t = 8.33; P < .0001). During
the same period, there was no significant change in the mean vaccination
rates in the comparison clinic. CONCLUSIONS: An organizational strategy
appears to be a useful method to reduce missed opportunities and improve
measles-mumps-rubella vaccination rates in adolescents from a low
socioeconomic population.
