Wood D, Saarlas K N, Inkelas M, Matyas B T
Shriners Hospitals, Tampa, Florida, USA.
Annu Rev Public Health. 1999;20:231-55. doi: 10.1146/annurev.publhealth.20.1.231.
Although immunization rates among children are rising across the country, rates in inner-city areas have remained at approximately 50%-60%, < or = 30% lower than corresponding suburban or state immunization levels. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Immunization registries are a new tool in health care that can be used to address these and other barriers to effective immunization delivery. Moreover, immunization registries have the potential to help health care officials track and improve delivery for a broad range of important child health services. An immunization registry is a computerized database of information on children (usually preschool-age children) in a defined population (e.g. those enrolled in a health maintenance organization or living in a specific geographic area), which is used to record and track all immunizations received by each child. The registry receives the information primarily from public and private providers that administer immunizations, as well as from parents, schools, and other agencies. A fully functioning immunization registry can be used to identify individual children in need of immunizations and to report on immunization rates by population characteristics such as child age, assigned provider, or geographic area (e.g. neighborhood, city). Today, > 250 local public health departments have immunization registries that are in various stages of planning or development. Only a small number of these registries meet the minimum functional criteria of maintaining records on 95% of all eligible 2-year-old children in the target population and providing an electronic immunization record that is accessible to providers. Nascent immunization registries represent innovative technologic solutions to the challenge of monitoring health problems and health care access on a population basis. This is a fundamental activity of public health agencies, but one that is increasingly shared by large health maintenance organizations. The study of the development of immunization registries across the United States provides an important case study for how public health agencies will use the rapidly developing health information infrastructure to perform health assessment and health assurance activities in a managed care environment.
尽管全国儿童免疫接种率在不断上升，但市中心城区的接种率仍维持在约50%-60%，比相应的郊区或全州免疫接种水平低30%或更低。贫困、服务不足人群的免疫接种水平未能提高，部分原因是缺乏针对医护人员和家长的及时、准确的儿童特定免疫接种信息。免疫接种登记系统是医疗保健领域的一种新工具，可用于克服这些及其他有效提供免疫接种的障碍。此外，免疫接种登记系统有潜力帮助卫生保健官员跟踪并改进一系列重要儿童健康服务的提供情况。免疫接种登记系统是一个计算机化数据库，记录特定人群（如参加健康维护组织或居住在特定地理区域的人群）中儿童（通常为学龄前儿童）的信息，用于记录和跟踪每个儿童接种的所有疫苗。该登记系统主要从进行免疫接种的公立和私立医疗机构获取信息，也从家长、学校及其他机构获取信息。一个功能完备的免疫接种登记系统可用于识别需要接种疫苗的儿童个体，并按儿童年龄、指定医疗机构或地理区域（如社区、城市）等人群特征报告免疫接种率。如今，超过250个地方公共卫生部门拥有处于不同规划或发展阶段的免疫接种登记系统。其中只有少数登记系统达到了最低功能标准，即记录目标人群中95%符合条件的2岁儿童的信息，并提供可供医疗机构访问的电子免疫接种记录。新兴的免疫接种登记系统代表了在人群基础上监测健康问题和医疗保健可及性挑战的创新技术解决方案。这是公共卫生机构的一项基本活动，但大型健康维护组织也越来越多地参与其中。对美国各地免疫接种登记系统发展情况的研究，为公共卫生机构如何利用快速发展的健康信息基础设施在管理式医疗环境中开展健康评估和健康保障活动提供了一个重要的案例研究。
