The impact of record scattering on the measurement of immunization coverage
The impact of record scattering on the measurement of immunization coverage
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DOI：
10.1542/peds.107.1.91
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发表时间：
2001-01-01
期刊：
影响因子：
8
通讯作者：
Maes, EF
中科院分区：
文献类型：
--
作者：
Stokley, S;Rodewald, LE;Maes, EF
背景缺乏统一的免疫记录可能会导致在门诊就诊时确定个人免疫需求以及测量临床医生实践或社区人口的疫苗接种覆盖水平的问题。对于有多个免疫接种提供者的儿童，使用所有响应免疫接种提供者的数据与以下数据进行比较，评估覆盖水平的差异：1）最近的免疫接种提供者的记录，2）第一个免疫接种提供者的记录，3）随机选择的免疫接种提供者的记录。确定最近的供应商，可能与报告不完整的免疫史的特点。数据来自1995年全国免疫提供者记录检查研究（NIPRCS）进行分析。NIPRCS是一项提供者验证研究，对国家健康访谈调查（NHIS）中包括的所有19至35个月大的儿童的家庭报告免疫史进行验证。提供者确定的儿童的父母在NHIS的采访邮寄一份2页的调查报告所有免疫接种（类型和日期）的孩子收到，无论提供者谁管理的镜头，和孩子的第一次和最近的访问日期的做法。在1352名有提供者数据的儿童中，有304名（22%）接受了不止一个提供者的免疫接种。与来自所有提供者的信息相比，根据疫苗的不同，最近的提供者记录将覆盖率低估了9.6至13.4个百分点;最初的提供者记录将覆盖率低估了15.6至34.6个百分点;随机选择的提供者记录将覆盖率低估了10.0至20.7个百分点。公共设施和患者病历中有免疫汇总表与完整记录相关。分散的免疫接种记录大大损害了临床医生确定在其他卫生保健场所接受免疫接种的患者的免疫接种状态的能力。减少免疫记录分散问题的一些战略包括在实践层面上对免疫覆盖率进行评估，实施召回制度，以及建立全社区的免疫登记册。
Background. Lack of a consolidated immunization record may lead to problems with determining individual immunization needs at office visits as well as measuring vaccination coverage levels of a clinician's practice or a community's population.Objectives. For children with multiple immunization providers, evaluate the difference in coverage levels using data from all responding immunization providers compared with: 1) the most recent immunization provider's records, 2) the first immunization provider's records, and 3) a randomly selected immunization provider's records. Identify characteristics of the most recent provider that may be associated with reporting incomplete immunization histories.Methods. Data from the 1995 National Immunization Provider Record Check Study (NIPRCS) were used for analysis. The NIPRCS is a provider validation study of the household reported immunization histories of all children 19 to 35 months of age included in the National Health Interview Survey (NHIS). Providers identified by the child's parent during the NHIS interview are mailed a 2-page survey to report all immunizations (type and date) the child received, regardless of the provider who administered the shots, and child's first and most recent visit dates to the practice.Results. Of the 1352 children with provider data, 304 (22%) had received immunizations from more than one provider. Compared with information from all providers and depending on the vaccine, the most recent provider records underestimated coverage by 9.6 to 13.4 percentage points; the initial provider records underestimated coverage by 15.6 to 34.6 percentage points; and the randomly selected provider records underestimated coverage by 10.0 to 20.7 percentage points. Public facilities and having an immunization summary sheet in the patient's chart were associated with having complete records.Conclusion. Scattered immunization records significantly compromise the ability of clinicians to determine the immunization status of their patients who received immunizations at other sites of health care. Routinely assessing immunization coverage levels at the practice level, implementing a recall system, and developing community-wide immunization registries are some strategies to reduce the problem of scattered immunization records.