Improving Immunization Rates in Private Pediatric Practices Through Physician Leadership

OBJECTIVE: To determine whether a physician-led quality improvement initiative can improve immunization rates in participating private practices. DESIGN: Surveys of private pediatric practices at 6-month intervals over an 18-month period. SETTING: Ten private pediatric practices in Norfolk and Virginia Beach, Va. PATIENTS: Children aged 9 to 30 months attending the private practices. INTERVENTIONS: Practice immunization rates were assessed and presented to practices on 4 occasions at 6-month intervals. A physician leader convened an immunization task force meeting following the first 3 assessments to review practice guidelines, examine data, and discuss practice changes. MAIN OUTCOME MEASURES: Practice immunization rates for patients at age 24 months, with 3- and 12-month immunization rates as secondary outcomes. RESULTS: The mean practice immunization rate at age 24 months increased significantly (P<.05) from 50.9% at baseline to 69.7%. Rates also increased at age 3 months, from 75.5% to 88.9%, and at age 12 months, from 72.9% to 84.6%. The median age at administration of the fourth dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccine decreased (P<.05) from 17.6 to 16.8 months. Physicians also reported making additional changes, including improved record keeping and screening for immunizations at every visit. CONCLUSION: A quality improvement initiative enabling physician leadership can improve preschool immunization practices and coverage levels in pediatric practices.