The Effect of Education, Feedback, and Provider Prompts on the Rate of Missed Vaccine Opportunities in a Community Health Center

The purpose of this study was to determine whether education, feedback, and provider prompts decrease the rate of missed vaccine opportunities; and the reasons for missed opportunities in the post-intervention group. A nonrandomized, before and after study to evaluate the effect of education, feedback, and provider prompts on missed opportunities was conducted in an inner-city community health center with a predominantly hispanic population. Vaccine opportunities were defined as visits of children 36 months or younger who were vaccination-eligible by ACIP guidelines. Consecutive sampling was used to identify two groups of children with vaccine opportunities: pre- and post-intervention. Feedback was given to vaccine providers on the frequency of missed opportunities in the pre-intervention group. The ACIP recommended vaccine schedule and true vaccine contraindications were reviewed. Nursing personnel were taught to identify and tag charts of children with vaccine opportunities. Physicians were asked to record vaccination status and the reason any vaccination was deferred. Missed opportunities decreased significantly, from 49% (173/352) to 13% (45/344), after the interventions (p < 0.001). The reasons for the 45 missed opportunities in the post-intervention sample were parent refusal (15.6%), moderate or severe illness (15.6%), and incorrect documentation as "up-to-date" (13.3%). In 28.9% there was a missed opportunity for simultaneous immunization. No reasons were documented for the remaining missed opportunity visits (26.6%). The interventions, which emphasized improving provider knowledge of vaccinations and screening vaccine status at each visit, effectively decreased missed opportunities.