Operational conditions affecting the vaccination of older adults.

Background: The content and context of the process of vaccinating older adults against influenza in outpatient settings has not been adequately described. Failure to appreciate the causal antecedents or precursors to the act of provider recommendation may explain why so many efficacious interventions identified by the U.S.

The price of prevention. cost of recommended activities to improve immunizations.

Purpose: To calculate the cost structure of a suite of immunization improvement interventions recommended by the Centers for Disease Control and Prevention (CDC).

Methods: A determination was made of the cost to clinics and agencies that implement a suite of CDC-recommended practice improvement interventions to fully immunize a child for diphtheria-tetanus-attenuated pertussis (DTaP), inactivated poliovirus (IPV), and measles-mumps-rubella (MMR) vaccines. Patient data were collected through chart analysis of 16-month-old children in clinics participating in this study's interventions between May 1997 and August 2000.

Can the doctor still see me? What happens when patients arrive late?

Demands to optimize productivity and quality require a patient scheduling system that can balance patient demand and clinic resources. The consequences of unscheduled and late patient arrivals on operational efficiencies have been documented. Less understood is the impact of unscheduled and late arrivals on the quality of service each receives.

A prenatal intervention study to improve timeliness of immunization initiation in Latino infants.

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups.

The cost of doing business: cost structure of electronic immunization registries.

Objective: To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis.

Data Sources/study Setting: Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period.

Study Design: A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements.

Non-punctual patients: planning for variability in appointment arrival times.

Tighter competition and rationed resources place a premium on health clinic management of patient arrival times to maximize smooth workflow dynamics and consistency in patient processes. Early efforts to analyze patient arrival characteristics relied on assumptions that may have been too simplistic. For instance, it was assumed that a scheduled patient's arrival was likely to fit a bell-shaped curve in terms of being early, late, or on time and that any one patient's likelihood of being "on time" was purely a random event.

Provider-staff discrepancies in reported immunization knowledge and practices.

Background: The purpose of the study was to compare immunization-relevant knowledge, certainty about knowledge, self-efficacy, vested interest, and reported practices of providers and clinical staff in the same clinics.

Methods: A valid and reliable instrument measuring the aforementioned issues was developed and administered to a sample of 50 providers and 60 members of the clinical staff.

Results: Providers were significantly more knowledgeable than staff (P < 0.

Missed opportunities to immunize: psychosocial and practice correlates.

Background: The goal of this pilot study was to correlate missed opportunities to immunize young children with providers' psychosocial characteristics and self-reported immunization practices.

Methods: In a population of children aged 0 to 36 months, missed opportunities to immunize were established for a sample of 28 providers, who also responded to a valid and reliable instrument measuring the aforementioned variables.

Results: Missed opportunities were significantly lower among providers with higher vested interest (r=-0.

The forms that bind: multiple data forms result in internal disaggregation of immunization information.

To examine how forms encountered during routine clinical activities impact a provider's immunization activity, workflow analysis was performed in nine community clinics and small private practices. Data gathered included the number, source, and nature of forms. A total of 200 forms were used by the nine clinics just for children under 35 months of age.