Article Text

  1. H. M. Lemon*,
  2. E. J. Slora*,
  3. R. C. Wasserman*,
  4. A. B. Bocian*,
  5. H. W. Clegg*,
  6. D. P. Norton*,
  7. P. M. Darden*
  1. *Medical University of South Carolina, Charleston


Background Measuring practice-specific immunization rates has become more complicated with HIPAA.

Objective To validate a new, HIPAA-compliant method for tracking immunization rates.

Methods Five practices in the AAP's practice-based research network, Pediatric Research in Office Setting Network (PROS), collected immunization data on 50 consecutive patients aged 8-35 months using two methods. The reference standard method used two trained research nurses independently examining photocopied patient Vaccine Administration Records with resolution of any disagreement. In the quick-count (QC) method, each office staff recorded counts of the number of patient vaccine doses without submitting patient identifiable information. Up-to-date immunization status (UTD) at 8 months of age was assessed for each patient. Vaccines assessed were DTaP, Hib, Hep B, and polio vaccines. UTD was defined as 3 DTaP, 2 Hib, 2 Hep B and 2 polio vaccines. Measures examined included kappa, sensitivity, specificity, positive predictive value, and negative predictive value.

Results Both methods were used to assess 237 patients. The mean percentage of patients' UTD by 8 months of age using the reference standard method was 93% (practice range 85%-98%). The mean percentage of patients UTD by the QC method was 92% (practice range 83%-98%). No significant difference was found between the methods in assessing an individual's UTD immunization status (McNemar's test p > .18). Agreement with the reference standard was excellent (kappa = 0.85). QC was highly sensitive in determining up-to-date immunization status (99.5%) and had a specificity of (79%). QC had a positive predictive value for up-to-date immunizations of (98%) and negative predictive value of (94%). A debriefing survey demonstrated that all practices found the QC data collection form easy to follow.

Conclusion We found the QC method to be a valid, reliable, and HIPAA-compliant tool for assessing practice immunization rates. In this era of increased patient privacy concerns, this new method of efficiently extracting immunization information will be a valuable tool for research and quality improvement directed at improving immunization rates.

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