Davidson Arthur J, Melinkovich Paul, Beaty Brenda L, Chandramouli Vijayalaxmi, Hambidge Simon J, Phibbs Stephanie L, Braun Patricia, LeBaron Charles W, Steiner John F
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Am J Prev Med. 2003 Apr;24(3):276-80. doi: 10.1016/s0749-3797(02)00638-4.
Healthcare systems have been challenged to ensure the timely administration of immunizations. Immunization registries have been proposed to improve the accuracy and completeness of immunization information and to promote effective practice.
Comparison of randomly selected samples from two birth cohorts (1993 and 1998) from Denver Health Medical Center. Chart review and immunization registry information for these groups were compared; a composite immunization was recorded and up-to-date (UTD) status established. Registry data were compared with this composite using a sensitivity measure to assess completeness and accuracy.
Among 818 children in the 1993 cohort and 1043 children in the 1998 cohort, there were 6386 and 6886 valid immunizations, respectively. The registry recorded 71.4% and 97.7% of these for the 1993 and 1998 cohorts, respectively (p <0.001). The apparent UTD rate, as measured with registry data alone, improved from 37% to 79% between the two time frames (p <0.001). Composite UTD status was 83.1% and 78.9% (1993 vs 1998, respectively). Accurate registry-defined UTD status improved from 44.4% to 100% between the two intervals.
Immunization registry accuracy improved dramatically for recorded immunizations and UTD status. However, after 3 years of registry use, the overall proportion of children who were UTD had not significantly improved. The mere presence of a registry does not ensure more complete vaccination coverage. Other registry-based strategies, including use of the data for reminder, recall, and audit, may further improve immunization coverage.
医疗保健系统面临着确保及时接种疫苗的挑战。有人提议建立免疫接种登记系统，以提高免疫接种信息的准确性和完整性，并促进有效实践。
对丹佛健康医疗中心两个出生队列（1993年和1998年）中随机抽取的样本进行比较。比较了这些组的病历审查和免疫接种登记信息；记录了综合免疫接种情况并确定了最新（UTD）状态。使用敏感性测量方法将登记数据与该综合数据进行比较，以评估完整性和准确性。
在1993年队列的818名儿童和1998年队列的1043名儿童中，分别有6386次和6886次有效免疫接种。登记系统分别记录了1993年和1998年队列中这些接种的71.4%和97.7%（p<0.001）。仅根据登记数据测量的表观UTD率在两个时间框架之间从37%提高到了79%（p<0.001）。综合UTD状态分别为83.1%和78.9%（分别为1993年与1998年）。在两个时间段之间，准确的登记定义的UTD状态从44.4%提高到了100%。
免疫接种登记系统在记录的免疫接种和UTD状态方面的准确性有了显著提高。然而，在使用登记系统3年后，UTD儿童的总体比例并未显著提高。仅仅存在登记系统并不能确保更完整的疫苗接种覆盖率。其他基于登记系统的策略，包括将数据用于提醒、召回和审核，可能会进一步提高免疫接种覆盖率。
