文章基本信息

标题：The Regional Immunization Registry as a Public Health Tool for Improving Clinical Practice and Guiding Immunization Delivery Policy
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作者：Allison Kempe ; Brenda L. Beaty ; John F. Steiner 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：6
页码：967-972
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed the distribution of immunization records among 3 health care delivery sectors and the impact of a regional immunization registry on “up to date” rates. Methods. Immunization registry records in 2 regions were categorized as having originated in private practices, community health centers, or public health clinics. “Up to date” rates were calculated after we sequentially added immunization records from the 3 sectors. Results. The percentage of children with immunizations documented in multiple sectors increased with age from 7 to 24 months, and children who were seen in multiple sectors were more likely to be up to date. There were relative increases in “up to date” rates of 50% for children aged 24 months. Conclusions. The regional immunization registry is a powerful public health tool for increasing documented “up to date” rates and providing insights into patterns of immunization delivery. The National Immunization Program of the Centers for Disease Control and Prevention advocates the use of computerized immunization registries as an integral part of efforts to increase immunization rates. 1 Immunization registries allow providers to monitor immunization records and to generate reminder and recall notices for underimmunized children. 2– 10 When such registries are population-based and include all patients in a given area, they consolidate immunization records that are scattered among multiple providers, which facilitates the targeted recall of children who are truly underimmunized and decreases the chances of a child’s being overimmunized. 2 Record scatter is a significant barrier to accurate assessment of immunization “up to date” rates, especially in rural areas. 11– 14 In fact, the problem of record scatter and the burden of trying to track immunizations are significant deterrents to rural primary care physicians’ participation in immunization delivery. 11 The resultant practice of referring patients to public health clinics for immunization undermines the concept of the “medical home,” defined by the American Academy of Pediatrics as “accessible, comprehensive, continuous and coordinated health care delivery by a provider that is known to the family.” 15 There has been limited previous assessment of the extent of the record scatter problem at a population level. In our study, we approximated a population-based analysis of record scatter in 2 rural regions of Colorado. Our specific objectives were to (1) assess the distribution of immunization records in 3 sectors of the health care delivery system (private practices, community health centers, and public health clinics that deliver immunizations but provide no other primary care), (2) assess the relationship between “up to date” rates and having records exclusively in any 1 sector, and (3) assess the impact of a regional immunization registry on documented “up to date” rates.