Immunization assessments are used primarily for analyzing vaccination coverage levels and gaining a better understanding of immunization practices. Utah Immunization Program staff conduct annual or semi-annual
immunization record assessments of public and private clinics. These
assessments are conducted using a Centers for Disease Control and
Prevention (CDC) software package, Comprehensive Clinic Assessment Software Application
or (CoCASA).
An Immunization assessment provides an extensive amount of data that includes, but is not limited to:
A diagnostic report that highlights immunization practices in your clinic
The up-to-date immunization status of two-year-olds served by your clinic
The up-to-date immunization status of children at critical ages (i.e. 3, 5, 7 or 19 months-of-age)
Antigen-specific immunization coverage levels
The proportion of children who "drop out" of the vaccination schedule
The extent of missed opportunities
to vaccinate
Reports produced by CoCASA also indicate the extent to which vaccination levels can be improved by:
Administering multiple vaccines simultaneously
Using accelerated vaccination schedules
Encouraging parents to initiate the immunization series on time
Note: Only documented vaccination dates can be entered into the CoCASA software to determine immunization coverage levels. Therefore, an effective assessment requires complete documentation of vaccination dates for all vaccines from current and previous providers.
If an immunization record indicates vaccinations were given at another health clinic and vaccination dates are not provided, those immunizations can not be entered into the CoCASA software.
An immunization assessment involves:
Inputting immunization records
of at least 50 patients 24-35 months-of-age
Inputting chickenpox disease status
Analyzing data
Identifying reasons for low immunization levels
Diagnosing immunization delivery problems
Developing solutions and setting incremental goals
The purpose of immunization assessments is to:
Distinguish between perceived immunization levels
and actual immunization levels
Measure data
Monitor changes in the data
Improve immunization coverage levels
Bring about changes in policies and procedures
Compare results and exchange information
Discover immunization delivery problems
How can an assessment be used as a diagnostic tool?
Assessments
help identify the following problems:
Late starts
Non-adherence to the Advisory Committee on Immunization Practices (ACIP) schedule
Children falling behind in the immunization schedule
Failure to use an accelerated ACIP schedule when needed
Ineffective reminder/recall systems
Failure to give vaccines simultaneously
Inadequate record keeping and documentation
Common Factors That Influence Immunzation
Levels in Clinics
Incomplete documentation of immunizations (immunization histories missing specific dates for administered vaccine doses) gives an artificially low assessment.
Sources of missing immunization data include:
Immunization records not provided by a parent
Dates from parent recall or immunizations given in your clinic that are not documented in the chart with a complete date (day/month/year)
Mobile population - Families with newborns move within a year, which hinders continuity of care. This also impacts efforts to implement effective tracking and reminder/recall systems.
Immunization Strategies
The following information represents some possible ideas for improving immunization levels in a clinical practice. It is likely that a combination of strategies, rather than any single strategy, will be effective in raising immunization coverage levels.
Documentation of Immunization
Histories
The CDC recommends that immunizations be given based on documented immunization histories, i.e., child's clinic medical record, parent maintained immunization card, or verbal/written confirmation of immunizations from another provider. This documented history should contain the day/month/year shots
were given.
Many parents do not keep their child's immunization card or may forget to bring it. Additionally, the record may not reflect all immunizations received by the child. The parent/guardian who comes to the clinic without a documented immunization history presents challenges to clinic staff. An attempt to contact the clinic where the previous immunizations were given is the most obvious first step. However, this may be impractical, due to time constraints or inaccessibility of the other provider(s).
The Utah Statewide Immunization Information System (USIIS), an immunization registry that allows a child's immunization history to be shared among providers, may alleviate much of this problem. However, until all providers are enrolled in USIIS, the following solutions need to be considered:
Call the other provider(s) for the missing immunization history during the clinic visit.
Send a pre-addressed stamped postcard to obtain an immunization history.
Record all immunizations in a prominent location in the medical chart and use current immunization recording forms that have areas to record each recommended vaccine.
If a parent brings in an immunization record card, update their
record card for them or indicate which immunizations were given, so the parent can
record them.
Reminder/Recall and Tracking Systems
Each step of this process should be examined to determine what more can or should be done given clinic resources and parent responsiveness. Research tells us that parents respond most positively and take action when a provider tells them immunizations are needed. What works best is direct contact between provider and parent.
Reminders - A reminder card involves giving or sending a card with a date to return for a subsequent visit. Consider having a parent or guardian complete the reminder card during their child's visit. Phone reminders work as a supplement to a postcard system.
Recall - Clinics can use postcards to recall patients who have not returned within a certain number of days after immunizations are due. These may be supplemented with a phone call which may:
Encourage them to seek immunizations
Assist in gathering missing immunization histories
Establish an inactive status, such as moved or seeing another provider
Tracking systems - Tracking systems may be manual or computerized, such as those used in the USIIS. The choice depends on your clinic resources, size and ability to link into other record keeping systems.
Maximizing Immunization Opportunities
Three additional areas to maximize opportunities can be explored:
Simultaneous immunizations - Providing simultaneous immunizations is a problem area for both public and private providers. Discuss
ways you might make improvements.
Giving immunizations at visits other than well-child visits - It is important to
vaccinate children whenever they are in the clinic. Flagging the records of children
who need immunizations may alert you to give immunizations when a child is seen for an emergency or follow-up visit. Flagging a chart may also be helpful for
children who started the series late and should receive immunizations on an
accelerated schedule.
Contraindications - True and false contraindications can be reasons for under
immunization. If vaccines are not given or postponed because of a contraindication, documentation should be indicated in the medical chart.
For more information on immunization assessments or to schedule an assessment in your clinic, contact the Utah Immunization Program at 801-538-9450.
