Bardenheier Barbara, Kong Yuan, Shefer Abigail, Zhou Fangjun, Shih Sarah
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Manag Care. 2007 Apr;13(4):193-200.
To examine recent trends in childhood immunizations recommended by the Advisory Committee for Immunization Practices measured by the Health Plan Employer Data and Information Set (HEDIS) and to describe the factors associated with higher rates over time.
The HEDIS performance measures from 1999 to 2002 and plan characteristics include approximately 400 enrollees per plan each year.
Longitudinal regression analysis of commercial managed care organizations' HEDIS measures. The outcome measure was the proportion of children aged 24 to 35 months in the plan who received 4 doses of diphtheriatetanus-pertussis vaccine, 3 doses of polio vaccine, 1 dose of measles-mumps-rubella vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine.
The mean immunization rate for health insurance plans increased from 65.7% in 1999 to 67.9% to 2002. Plans that reported publicly had higher childhood immunization rates than plans that did not report publicly (P < .001). Plans with higher proportions of Hispanics or African Americans had lower childhood immunization rates (P < .001). Immunization rates varied significantly by type of visit; plans with higher proportions of children making visits to their primary care physician had higher rates of immunization (P < .001).
Managed care organizations' performance measured by childhood immunization rates varies by organizational and demographic factors. Our findings suggest that plans should ensure efficient and accurate data collection systems and should encourage their providers to assess for immunizations at sick-child and well-child care visits.
通过健康计划雇主数据与信息集（HEDIS）来研究免疫实践咨询委员会推荐的儿童免疫接种近期趋势，并描述随时间推移与较高接种率相关的因素。
1999年至2002年的HEDIS绩效指标以及计划特征，每年每个计划约有400名登记者。
对商业管理式医疗组织的HEDIS指标进行纵向回归分析。结果指标是该计划中24至35个月大儿童接受4剂白喉 - 破伤风 - 百日咳疫苗、3剂脊髓灰质炎疫苗、1剂麻疹 - 腮腺炎 - 风疹疫苗、3剂b型流感嗜血杆菌疫苗和3剂乙型肝炎疫苗的比例。
健康保险计划的平均免疫接种率从1999年的65.7%升至2002年的67.9%。公开报告的计划比未公开报告的计划有更高的儿童免疫接种率（P <.001）。西班牙裔或非裔美国人比例较高的计划儿童免疫接种率较低（P <.001）。免疫接种率因就诊类型而异；儿童看初级保健医生比例较高的计划免疫接种率也较高（P <.001）。
以儿童免疫接种率衡量的管理式医疗组织绩效因组织和人口因素而异。我们的研究结果表明，计划应确保高效准确的数据收集系统，并应鼓励其提供者在儿童患病就诊和健康体检时评估免疫接种情况。
