LeBaron C W, Chaney M, Baughman A L, Dini E F, Maes E, Dietz V, Bernier R
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 1997 Feb 26;277(8):631-5.
To investigate whether a reported rise in vaccination coverage in Georgia public clinics during the period 1988 through 1994 was artifactual or real and, if real, to determine the extent to which the rise could be associated with a program of measurement and feedback.
Examination of data from Georgia public clinics, doses-administered records, and National Health Interview Surveys.
SETTING/PARTICIPANTS: Children attending Georgia public clinics.
Measurement of vaccination coverage and feedback to providers.
Vaccination coverage rates.
For the period 1988 through 1994, 136 004 Georgia public clinic vaccination records for children 21 to 23 months of age were reviewed. Median series-completion rates at public clinics rose from 53% to 89%, while indexes of under-vaccination fell: missed opportunities for simultaneous vaccination (6% to 0%), lost contact for more than 12 months (14% to 1%), and first vaccination more than 1 month late (19% to 8%). According to the independent doses-administered database, the proportion of children starting the primary series very late (> or =12 months old) fell from 14% to 6%, and the series-completion index rose from 64% to 83%, suggesting that improvements could not be wholly ascribed to better clinic record keeping. In 1988, vaccination coverage of children 24 months of age in the National Health Interview Survey (NHIS) was 53%, identical to median public clinic coverage in Georgia; in 1993, NHIS coverage was 60%, while median public clinic coverage in Georgia was 90%, suggesting that the rise in coverage in Georgia public clinics exceeded national trends. Patterns within the coverage changes suggest an association with the process of measurement and feedback.
A marked increase in vaccination coverage occurred in Georgia public clinics associated with a program of annual measurement and feedback.
调查1988年至1994年期间佐治亚州公共诊所报告的疫苗接种覆盖率上升是人为造成的还是真实的，如果是真实的，确定这种上升与测量和反馈计划相关的程度。
对佐治亚州公共诊所的数据、疫苗接种剂量记录和国民健康访谈调查进行检查。
设置/参与者：在佐治亚州公共诊所就诊的儿童。
测量疫苗接种覆盖率并向提供者反馈。
疫苗接种覆盖率。
在1988年至1994年期间，对佐治亚州公共诊所136004份21至23个月龄儿童的疫苗接种记录进行了审查。公共诊所的系列疫苗接种完成率中位数从53%上升到89%，而疫苗接种不足指标下降：同时接种的错过机会率（从6%降至0%）、超过12个月失去联系率（从14%降至1%）以及首次接种延迟超过1个月率（从19%降至8%）。根据独立的疫苗接种剂量数据库，开始主要疫苗接种系列非常晚（≥12月龄）的儿童比例从14%降至6%，系列疫苗接种完成指数从64%升至83%，这表明改善不能完全归因于更好的诊所记录保存。1988年，国民健康访谈调查（NHIS）中24月龄儿童的疫苗接种覆盖率为53%，与佐治亚州公共诊所的覆盖率中位数相同；1993年，NHIS覆盖率为60%，而佐治亚州公共诊所的覆盖率中位数为90%，这表明佐治亚州公共诊所的覆盖率上升超过了全国趋势。覆盖率变化中的模式表明与测量和反馈过程有关。
佐治亚州公共诊所的疫苗接种覆盖率显著上升，这与年度测量和反馈计划有关。
