Effectiveness of chart prompt about immunizations in an urban health center

Abstract

Objective: To determine whether a nurse-initiated chart review and prompt to physicians is an effective method to increase immunization rates.

Study design: This study was a controlled trial with systematic assignment of children to intervention or control groups based on chart number. Each day, a nurse reviewed the charts of children to be seen that day who were in the intervention group. The nurse prepared a 1-page form about the child's immunization status that requested permission from the physician to administer needed vaccines and attached the form to the chart. The duration of the study period was 1 year.

Population: Nine hundred ninety-seven pediatric patients attending 2 inner-city primary care health centers.

Outcome measured: On-time immunization rates in both groups.

Results: Among children eligible to receive vaccines during the study period, a higher percentage in the intervention group received on-time vaccines for diphtheria/tetanus/pertussis-4 (DTP4; 51% vs 36%; P=.03), oral polio vaccine-3 (OPV3; 70% vs 56%, P=.04), and measles/mumps/rubella-1 (42% vs 26%; P=.01) than did children in the control group. No statistically significant differences were noted for DTP3, DTP5, hepatitis B3, or OPV4. No statistically significant difference was noted for the combined series (ie, all age-appropriate immunizations as recommended by the 1995 Childhood Immunization Schedule of the Centers for Disease Control and Prevention).

Conclusions: The chart prompt increased on-time immunizations for some antigens.