Identification and recall of children with chronic medical conditions for influenza vaccination
Identification and recall of children with chronic medical conditions for influenza vaccination
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DOI：
10.1542/peds.113.1.e26
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发表时间：
2004-01-01
期刊：
影响因子：
8
通讯作者：
Kempe, A
中科院分区：
文献类型：
--
作者：
Daley, MF;Barrow, J;Kempe, A
目标.尽管长期以来一直建议为患有慢性疾病的儿童提供年度流感疫苗接种，但选择了在过去24个月内HRC的免疫接种率= 1次，HRC来自国际疾病分类，第九次修订版，临床修改诊断代码。我们以医疗记录为“金标准”，随机选择327份记录，以确定识别HRC的账单数据的敏感性、特异性和准确性。对于HRC儿童，我们随后进行了一项随机对照试验，提醒/召回流感疫苗接种。召回试验的主要结果是接受流感疫苗。在确定哪些儿童有HRC方面，账单数据的敏感性为72%（95%置信区间[CI]：48%-95%），特异性为95%（95% CI：90%-100%），总体准确性为90%（95% CI：84%-96%）。在17273例6 - 72个月的患者中，2007年有>= 1个HRC（总体为12%;范围：每个实践为9%-14%）。哮喘/反应性气道疾病占所有HRC的87%。提醒/召回显著增加了HRC儿童的流感疫苗接种率，召回儿童的疫苗接种率为42%，而对照组为25%。与对照组受试者相比，召回受试者更有可能进行办公室访问（68%对60%），并且不太可能错过免疫接种机会（28%对37%）。基于诊断的计费数据准确地识别了患有HRC并需要每年接种流感疫苗的儿童，并且登记驱动的提醒/召回显著增加了目标儿童的流感疫苗接种。
Objectives. Despite long-standing recommendations to provide annual influenza vaccination to children with chronic medical conditions, immunization rates are = 1 encounters for an HRC in the previous 24 months were selected, with HRCs identified from International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Using medical records as the "gold standard," we reviewed 327 randomly selected records to determine the sensitivity, specificity, and accuracy of billing data for identifying HRCs. For children with an HRC, we then conducted a randomized, controlled trial of reminder/recall for influenza vaccination. The primary outcome of the recall trial was receipt of influenza vaccine.Results. Billing data had a sensitivity of 72% (95% confidence interval [CI]: 48%-95%), specificity of 95% (95% CI: 90%-100%), and overall accuracy of 90% (95% CI: 84%-96%) in determining which children had an HRC. Of the 17 273 patients aged 6 to 72 months, 2007 had >= 1 HRCs (12% overall; range: 9%-14% per practice). Asthma/reactive airways disease accounted for 87% of all HRCs. Reminder/recall significantly increased influenza immunization in children with HRCs, with a vaccination rate of 42% in those recalled, compared with 25% in control subjects. Recalled subjects were more likely to have an office visit (68% vs 60%) and less likely to have a missed opportunity to immunize (28% vs 37%) compared with control subjects.Conclusions. Diagnosis-based billing data accurately identified children who had HRCs and needed annual influenza vaccination, and registry-driven reminder/recall significantly increased influenza immunization in targeted children.