Yawn B P, Edmonson L, Huber L, Poland G A, Jacobson R M, Jacobsen S J
Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA.
Am J Manag Care. 1998 Feb;4(2):185-92.
We developed a simulated immunization registry to assess the impact on the perceived immunization status in a population-based sample of 2-year-olds living in Olmsted County, MN, in 1995. We compiled records of all immunizations by abstracting immunization data from all medical care facilities in the county. The data collected from each facility were analyzed separately to provide the immunization rate as perceived by each facility. This perceived rate was compared to the rate obtained by combining all recorded immunizations from all facilities (simulated registry). Information on children not receiving any carefrom facilities in Olmsted County was compiled from birth certificate data and community school lists. Data from the simulated registry indicated that 69.1% of all children in Olmsted County with medical records were up-to-date on their immunizations by 20 months of age. By 24 months, this increased to 74.2%. The immunization rate of 24-month-old children recorded at individual healthcare facilities in Olmsted County ranged from 24.3% to 79.5%. The addition of data from the simulated registry increased the immunization rate at each site: a 27.7% relative increase in the site with the lowest recorded immunization rate, a 14.0% increase in the site with the intermediate immunization rate, and a 6.9% increase in the site with the highest internally perceived immunization rate. The registry also identified excess immunizations in 5% of the county's 2-year-olds. Each healthcare facility in this community gained an immediate benefit from the development of a simulated immunization registry. This immediate improvement in one quality-of-care measure (up-to-date immunization rate) should be factored into the cost/benefit assessment of immunization registries.
1995年，我们建立了一个模拟免疫接种登记系统，以评估其对明尼苏达州奥尔姆斯特德县2岁儿童这一基于人群的样本中感知免疫接种状况的影响。我们通过从该县所有医疗保健机构提取免疫接种数据，汇编了所有免疫接种记录。对从每个机构收集的数据分别进行分析，以提供每个机构所感知的免疫接种率。将这个感知率与通过合并所有机构的所有记录免疫接种情况（模拟登记系统）获得的率进行比较。从出生证明数据和社区学校名单中汇编了未在奥尔姆斯特德县机构接受任何护理的儿童的信息。模拟登记系统的数据表明，奥尔姆斯特德县有医疗记录的所有儿童中，69.1%在20个月大时免疫接种及时。到24个月时，这一比例增至74.2%。奥尔姆斯特德县各医疗保健机构记录的24个月大儿童的免疫接种率在24.3%至79.5%之间。模拟登记系统的数据补充提高了每个机构的免疫接种率：记录的免疫接种率最低的机构相对提高了27.7%，免疫接种率中等的机构提高了14.0%，内部感知免疫接种率最高的机构提高了6.9%。该登记系统还发现该县5%的2岁儿童存在过度免疫接种情况。这个社区的每个医疗保健机构都从模拟免疫接种登记系统的建立中立即受益。在免疫接种登记系统的成本/效益评估中，应将护理质量指标之一（及时免疫接种率）的这一即时改善考虑在内。
