Lieu Tracy A, Massoudi Mehran R, Miroshnik Irina L, O'Brien Megan A, Coltin Kathryn L, Rodewald Lance E
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, and Harvard Medical School, Boston, Mass 02215, USA.
Am J Manag Care. 2003 Feb;9(2):121-7.
The National Scientific Panel on Immunization Measurement Standards recently recommended that the assessment population for the childhood immunization measure of the Health Plan Employer Data and Information Set include 24-month-olds with > or = 6 months of continuous enrollment in a health plan. The current inclusion criterion is > or = 12 months of continuous enrollment. The new recommendation would expand the assessment population to include children with more recent enrollment.
To compare the immunization status of children enrolled in a large health plan between ages 12 and 17 months vs earlier in life and to describe the proportion of children enrolled between ages 12 and 17 months that could be fully immunized by 24 months.
All children enrolled in a group-model HMO who turned 24 months old during a 12-month study were identified for a retrospective cohort study. A computerized immunization database was used to identify all vaccines administered to each child, and summary measures were created to describe immunization status at selected times. The full-text medical records of children who seemed to have no immunizations in the computerized database were reviewed.
Of the 3448 children in the study population, 3130 (91%) enrolled between birth and 11 months of age and 161 (5%) enrolled between 12 and 17 months of age. Whereas 87% of children who enrolled between birth and 11 months of age were fully immunized at age 24 months, only 57% of those enrolled between 12 and 17 months of age were fully immunized at 24 months of age (risk difference, 30%; 95% confidence interval, 24%-36%; P < .001). Of the 161 children enrolled between 12 and 17 months of age, 68% had received all of the immunizations in the primary series. Only 6% of these 161 children would have been impossible or difficult to fully immunize by age 24 months using accelerated catch-up vaccination schedules.
Children who enrolled in an HMO between 12 and 17 months of age were less likely than those who enrolled earlier in life to be fully immunized by age 24 months, but it would be feasible to bring almost all of them up to date by that age. Including such children in immunization measures, either together with earlier-enrolled children or as a separate stratum, would expand the scope of the quality of care under evaluation.
国家免疫测量标准科学小组最近建议，健康计划雇主数据与信息集儿童免疫措施的评估人群应包括连续参保健康计划≥6个月的24月龄儿童。目前的纳入标准是连续参保≥12个月。新建议将扩大评估人群，纳入参保时间更近的儿童。
比较大型健康计划中12至17月龄儿童与生命早期参保儿童的免疫状况，并描述12至17月龄参保儿童在24月龄时可实现完全免疫的比例。
确定在一项为期12个月的研究期间满24月龄的所有参加团体模式健康维护组织（HMO）的儿童，进行回顾性队列研究。使用计算机化免疫数据库确定每个儿童接种的所有疫苗，并创建汇总指标以描述选定时间的免疫状况。对计算机化数据库中似乎未接种任何疫苗的儿童的完整病历进行审查。
研究人群中的3448名儿童中，3130名（91%）在出生至11月龄之间参保，161名（5%）在12至17月龄之间参保。出生至11月龄之间参保的儿童中，87%在24月龄时实现了完全免疫，而12至17月龄之间参保的儿童中，只有57%在24月龄时实现了完全免疫（风险差异为30%；95%置信区间为24%-36%；P<.001）。在12至17月龄之间参保的161名儿童中，68%已接种了初级系列中的所有疫苗。使用加速补种疫苗接种计划，这161名儿童中只有6%在24月龄时不可能或难以实现完全免疫。
12至17月龄之间参加健康维护组织的儿童在24月龄时实现完全免疫的可能性低于生命早期参保的儿童，但在该年龄时使几乎所有此类儿童补种疫苗是可行的。将此类儿童纳入免疫措施，无论是与早期参保儿童一起还是作为一个单独的分层，都将扩大所评估的医疗质量范围。
