Improving pediatric immunization rates in a safety-net delivery system.

Background: Denver Community Health Services (DCHS)' goal was to increase childhood immunization rates in the high-risk pediatric patient population served through its safety-net delivery system. The specific goal of the initiative was to ensure that children younger than 3 years of age with at least one primary care visit received all recommended vaccines by 24 months of age.

Methods: An immunization registry was developed to accurately track patients, regular assessment of immunization levels were conducted with provision of clinic-specific feedback, and team-based quality improvement meetings were held. The computerized immunization registry assisted in implementing all the remaining improvement activities. For example, improvement of on-time delivery of vaccines in primary care clinics was accomplished through a rules engine in the vaccine registry, standing orders for vaccine delivery, and implementation of vaccine delivery protocols that eliminated missed opportunities.

Results: From 1995 to 2006, Denver Community Health documented a 47% increase in immunization rates for 2-year-old patients and a 26% increase for 1-year-old-patients. Two-year-old immunization rates exceeded 85% by the end of this time period.

Discussion: The initiative improved pediatric immunization rates with demonstrated sustainability during a 10-year period. Success is attributed to staff commitment to process improvement activities and use of a patient registry for pediatric immunization delivery.