By Institute of Medicine (U.S.). Committee on the Immunization Finance Dissemination, Institute of Medicine (U.S.). Division of Health Care Services
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Additional info for Setting the course: a strategic vision for immunization. Part 4: Summary of the Washington, D.C. Workshop, Parts 3-4
A critical finding of the case study reports is the transformation that occurred within state and local immunization programs during the 1990s. Fairbrother and colleagues (2000) observe that the shifting role of the public health clinics was one of the few generalizations that could be drawn from their study of nine different jurisdictions. This transformation in the immunization system includes several key components: • Public-sector clinics are now delivering a decreasing share of immunizations.
2000. Federal immunization policy and funding: A history of responding to crises. American Journal of Preventive Medicine 19(3S):99-112. Kenyon, TA, MA Martuck, and G Stroh. 1998. Persistent low immunization coverage among inner-city preschool children despite access to free vaccine. Pediatrics 101(4 Pt 1):612– 616. O’Bannon, JE, JP Mullooly, and MA McCabe. 1978. Determinants of lengths of outpatient visits in a prepaid group practice setting. Medical Care 16:226–244. Shaheen, MA, RR Frerichs, N Alexopoulos, and JJ Rainey.
The flowsheets also appear to increase influenza immunization rates within the diabetic population (32 percent of diabetics with flowsheets in the BCBSIL HEDIS Comprehensive Diabetes Care sample for 2000 who had a diabetes flowsheet in the medical record had received an influenza vaccination, compared to 17 percent who did not have a flowsheet). Improving childhood vaccination rates is a more difficult challenge because of the complexity of the childhood immunization schedule and the uncertainties among both providers and parents as to whether children are up to date at specified times.