Rodewald L, Maes E, Stevenson J, Lyons B, Stokley S, Szilagyi P
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Pediatrics. 1999 Apr;103(4 Pt 2):889-97.
The measurement of performance in the delivery of recommended vaccinations for children is used frequently as a marker for quality of care and as an outcome for studies of interventions to improve immunization coverage levels. The critical element of immunization performance measurement is the determination of immunization status. This methodologic review 1) discusses immunization status as a measure of quality of primary care for children, 2) describes immunization status measures used in immunization intervention studies, and 3) examines selected technical issues of immunization status measurement.
Immunization performance measurement has many characteristics of a robust quality of care measure, including high acceptance by primary care providers of routine vaccination, association of immunization status with the conduct of other clinical preventive services, agreed-on technical and programmatic standards of care, and legislative requirements for medical record documentation. However, it is not without challenges. Careful attention to technical issues has potential to improve immunization delivery health services research.
衡量儿童推荐疫苗接种的执行情况经常被用作医疗质量的指标以及改善免疫接种覆盖率干预措施研究的一项成果。免疫接种执行情况衡量的关键要素是确定免疫状态。本方法学综述：1）讨论免疫状态作为儿童初级保健质量衡量指标的情况；2）描述免疫接种干预研究中使用的免疫状态衡量指标；3）审视免疫状态衡量方面选定的技术问题。
1）通过对1980年至1997年间发表的关于提高免疫接种覆盖率干预措施的研究进行系统综述，描述免疫状态衡量指标的特征；2）利用一个本地免疫接种史数据库和一个国家免疫接种史数据库，说明免疫状态衡量的技术考量。免疫状态衡量的技术问题包括：1）需要使用有记录的免疫接种史而非家长回忆来确定免疫状态；2）需要整合不同医疗机构的记录以获取完整记录；3）免疫状态对缺失免疫接种数据的敏感性；4）包含多种疫苗接种组合的衡量指标可能低估人群疫苗接种程度的可能性。
免疫接种执行情况衡量具有可靠医疗质量衡量指标的许多特征，包括初级保健提供者对常规疫苗接种的高度接受度、免疫状态与其他临床预防服务开展情况的关联、公认的技术和程序护理标准以及病历记录的立法要求。然而，它也并非没有挑战。认真关注技术问题有可能改善免疫接种服务的卫生服务研究。
