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Impact of an Algorithm-Guided Nurse Intervention on the Use of Immunization Opportunities

Impact of an Algorithm-Guided Nurse Intervention on the Use of Immunization Opportunities Abstract Objective: To determine if a nurse intervention guided by an immunization algorithm was associated with an increased use of immunization opportunities at non–well-child care visits. Design: A controlled intervention trial of an algorithm-guided nurse intervention during a 5-month period. The use of immunization opportunities at an intervention site was compared with the use at this site during the previous year (the retrospective control group) and with that at a similar pediatric practice during the same period (the concurrent control group). Study Population: Children aged 2 to 60 months at 2 hospital-based pediatric practices that serve children of families with low to moderate incomes in Rochester, NY. Results: During the study periods, 2814 study children in the 3 groups made 5464 visits for non–well-child care. The use of immunization opportunities for diphtheria-tetanus-pertussis vaccine, live oral poliovirus vaccine, and measles-mumps-rubella vaccine at intervention visits was significantly better than at the visits of the retrospective or concurrent control groups (range of odds ratios, 1.9-2.5). Conclusion: An algorithm-guided nurse intervention improved the use of immunization opportunities at non–well-child care visits.Arch Pediatr Adolesc Med. 1997;151:384-391 References 1. Centers for Disease Control. Measles vaccination levels among selected groups of preschool-aged children—United States . MMWR Morb Mortal Wkly Rep . 1991;40:36-39. 2. National Vaccine Advisory Committee. The measles epidemic: the problems, barriers, and recommendations . JAMA . 1991;266:1547-1552.Crossref 3. Szilagyi PG, Rodewald LE, Humiston SG, et al. Missed opportunities for childhood vaccinations in office practices and the effect on vaccination status . Pediatrics . 1993;91:1-7. 4. McConnochie KM, Roghmann KJ. Immunization opportunities missed among urban poor children . Pediatrics . 1992;89:1019-1026. 5. Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. Proposal for clinical algorithm standards . Med Decis Making . 1992; 12:149-154.Crossref 6. Sox HC, Sox CH, Tompkins RK. The training of physician's assistants: the use of a clinical algorithm system for patient care, audit of performance and education . N Engl J Med . 1973;288:818-824.Crossref 7. Komaroff AL, Black WL, Flatley M, Knopp RH, Reiffen B, Sherman H. Protocols for physician assistants: management of diabetes and hypertension . N Engl J Med . 1974;290:307-312.Crossref 8. American Academy of Pediatrics Committee on Infectious Disease. 1991 Red Book . Elk Grove Village, Ill: American Academy of Pediatrics; 1991. 9. American Academy of Pediatrics Committee on Infectious Diseases. Haemophilus influenzae type b conjugate vaccines: recommendations for immunization of infants and children 2 months of age and older: update . Pediatrics . 1991; 88:169-172. 10. Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis . New York, NY: Oxford University Press Inc; 1982:176. 11. US Dept of Health and Human Services. Standards for Pediatric Immunization Practices . Washington, DC: US Dept of Health and Human Services; 1992. 12. Margolis CZ, Warshawsky SS, Goldman L, et al. Computerized algorithms and pediatricians' management of common problems in a community clinic . Acad Med . 1992;67:282-284.Crossref 13. Szilagyi PG, Rodewald LE, Humiston SG, et al. Immunization practices of pediatricians and family physicians in the United States . Pediatrics . 1994;94:517-523. 14. Brown J, Melinkovich P, Gitterman B, Ricketts S. Missed opportunities in preventive pediatric health care: immunizations or well-child care visits? AJDC . 1993;147:1081-1084. 15. Campbell JR, Szilagyi PG, Rodewald LE, Winter NL, Humiston SG, Roghmann KJ, Intent to immunize among pediatric and family medicine residents . Arch Pediatr Adolesc Med . 1994;148:926-929.Crossref 16. Orenstein WA, Bernier RH. Toward immunizing every child on time . Pediatrics . 1994;94:545-547. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Impact of an Algorithm-Guided Nurse Intervention on the Use of Immunization Opportunities

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1997.02170410058008
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine if a nurse intervention guided by an immunization algorithm was associated with an increased use of immunization opportunities at non–well-child care visits. Design: A controlled intervention trial of an algorithm-guided nurse intervention during a 5-month period. The use of immunization opportunities at an intervention site was compared with the use at this site during the previous year (the retrospective control group) and with that at a similar pediatric practice during the same period (the concurrent control group). Study Population: Children aged 2 to 60 months at 2 hospital-based pediatric practices that serve children of families with low to moderate incomes in Rochester, NY. Results: During the study periods, 2814 study children in the 3 groups made 5464 visits for non–well-child care. The use of immunization opportunities for diphtheria-tetanus-pertussis vaccine, live oral poliovirus vaccine, and measles-mumps-rubella vaccine at intervention visits was significantly better than at the visits of the retrospective or concurrent control groups (range of odds ratios, 1.9-2.5). Conclusion: An algorithm-guided nurse intervention improved the use of immunization opportunities at non–well-child care visits.Arch Pediatr Adolesc Med. 1997;151:384-391 References 1. Centers for Disease Control. Measles vaccination levels among selected groups of preschool-aged children—United States . MMWR Morb Mortal Wkly Rep . 1991;40:36-39. 2. National Vaccine Advisory Committee. The measles epidemic: the problems, barriers, and recommendations . JAMA . 1991;266:1547-1552.Crossref 3. Szilagyi PG, Rodewald LE, Humiston SG, et al. Missed opportunities for childhood vaccinations in office practices and the effect on vaccination status . Pediatrics . 1993;91:1-7. 4. McConnochie KM, Roghmann KJ. Immunization opportunities missed among urban poor children . Pediatrics . 1992;89:1019-1026. 5. Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. Proposal for clinical algorithm standards . Med Decis Making . 1992; 12:149-154.Crossref 6. Sox HC, Sox CH, Tompkins RK. The training of physician's assistants: the use of a clinical algorithm system for patient care, audit of performance and education . N Engl J Med . 1973;288:818-824.Crossref 7. Komaroff AL, Black WL, Flatley M, Knopp RH, Reiffen B, Sherman H. Protocols for physician assistants: management of diabetes and hypertension . N Engl J Med . 1974;290:307-312.Crossref 8. American Academy of Pediatrics Committee on Infectious Disease. 1991 Red Book . Elk Grove Village, Ill: American Academy of Pediatrics; 1991. 9. American Academy of Pediatrics Committee on Infectious Diseases. Haemophilus influenzae type b conjugate vaccines: recommendations for immunization of infants and children 2 months of age and older: update . Pediatrics . 1991; 88:169-172. 10. Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis . New York, NY: Oxford University Press Inc; 1982:176. 11. US Dept of Health and Human Services. Standards for Pediatric Immunization Practices . Washington, DC: US Dept of Health and Human Services; 1992. 12. Margolis CZ, Warshawsky SS, Goldman L, et al. Computerized algorithms and pediatricians' management of common problems in a community clinic . Acad Med . 1992;67:282-284.Crossref 13. Szilagyi PG, Rodewald LE, Humiston SG, et al. Immunization practices of pediatricians and family physicians in the United States . Pediatrics . 1994;94:517-523. 14. Brown J, Melinkovich P, Gitterman B, Ricketts S. Missed opportunities in preventive pediatric health care: immunizations or well-child care visits? AJDC . 1993;147:1081-1084. 15. Campbell JR, Szilagyi PG, Rodewald LE, Winter NL, Humiston SG, Roghmann KJ, Intent to immunize among pediatric and family medicine residents . Arch Pediatr Adolesc Med . 1994;148:926-929.Crossref 16. Orenstein WA, Bernier RH. Toward immunizing every child on time . Pediatrics . 1994;94:545-547.

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Apr 1, 1997

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