Feasibility of initiating and sustaining registry-based immunization recall in private practices.

OBJECTIVE: To assess the feasibility of initiating and sustaining immunization recall by private practices, including the barriers and costs, using a statewide immunization information system (IIS). METHODS: Private practices in southeast Michigan were recruited in 2007 to perform IIS-based immunization recalls. Enrolled practices were provided with training and asked to conduct 4 recalls during the course of 12 months of children 19 to 35 months of age. Each practice recorded the time they spent performing recall-related activities; labor costs were estimated. Formative and summative evaluations with semistructured interviews were conducted to identify barriers. RESULTS: Of 97 eligible pediatric and family medicine practices, 44 declined to participate, 32 did not respond to repeated contacts, and 20 agreed to enroll in the study (21%). A total of 56 recalls were conducted during the study period, with 9 practices completing at least 4 recalls and 7 practices completing 1 to 3 recalls; 4 practices conducted no recalls. Common barriers reported included time constraints and executing all steps of the recalls. Practice costs per patient recalled ranged from $0.05 to more than $6 and were primarily driven by the type of personnel who performed recalls. The costs of creating a roster of current patients comprised nearly one-half of total labor costs. CONCLUSIONS: Few private provider practices that we contacted were willing to participate in this study of IIS-based recall, and less than one-half of enrolled practices completed the desired 4 recall cycles in 12 months. Time constraints and other real-world problems should not be underestimated in determining the feasibility of practice-based immunization recall. Efforts to increase the use of a statewide IIS for recall in private practice settings should emphasize ongoing training and technical support to practice staff. Improved interoperability with electronic health record systems may foster practice-based recall by reducing the labor intensity of roster building and other recall activities.

Steroid inhaler adherence, flu vaccine receipt, and race: associations with the quality of the parent-physician relationship for asthmatic children.

RATIONALE: Steroid inhaler adherence and influenza immunization rates are low for asthmatic minority children. OBJECTIVE: To examine associations between parents' adherence to administering their child's steroid inhaler, influenza vaccine receipt, and parental perceptions of the primary care experience. METHODS: In 2006 we interviewed parents of children aged 2-12 who had an asthma-related physician visit in 2004 and 2005 about steroid inhaler use and influenza vaccine receipt. Parents rated their child's doctor using the Primary Care Assessment Survey (PCAS). MEASUREMENT: Outcome variables were inhaler adherence and influenza vaccine receipt. Independent variables included PCAS scores, child health measures, parental personal and financial stress, and demographic variables. RESULTS: Children of inhaler-adherent parents were more likely to be immunized (OR, 2.94; p = .03). Black parents were less adherent to steroid use (OR, 0.37, p = .01) while nonblack/nonwhite children had lower vaccination rates (OR, 0.29, p = .02). Continuity of care was associated with better inhaler adherence (OR, 1.02, p = .01). Influenza immunization was associated with physician's knowledge of the child's medical history (OR, 1.02, p = .05), interpersonal skills (OR, 1.02, p = .03), and parental trust in the physician (OR, 1.03, p = .02). Minority parents gave lower ratings than white parents to their child's physician and office on characteristics associated with inhaler adherence and immunization. CONCLUSIONS: Minority parents of asthmatic children are less adherent to recommended asthma treatments and rate physicians lower on characteristics associated with adherence. Improving those characteristics may improve asthma outcomes for minority children.

Who claims to be a pediatrician?

OBJECTIVE: The purpose of this study was to determine the proportion of physicians who self or otherwise declare themselves to be pediatricians but who have never achieved board certification. STUDY DESIGN: We compared a roster from the state licensure file of eight geographically diverse states containing those designated as pediatricians with a listing from the American Board of Pediatrics (ABP) of those who had ever achieved board certification. We then sent a mail survey to a sample of 500 physicians who appeared as pediatricians on the state licensure files but for whom there was no record of certification with the ABP. RESULTS: The proportion of unmatched pediatricians ranges from 6.9% in Massachusetts to 16.8% in Maryland, and averages 11% across all of the states in our study. The survey response rate was 64%. The majority (61%) of respondents described having undertaken residency training in categorical pediatrics or medicine-pediatrics. The remainder reported surgical residencies (31%) or were combined into an "other" category (8%). Eighty-five percent reported having completed 3 or more years of postgraduate training. Almost all (94%) completed training in the United States or Canada. CONCLUSIONS: There is increasing attention to board certification and patient safety among the media and public. A clearer delineation of the proportion of physicians in a given state reporting to be pediatricians who have not completed board certification can help inform parents of the odds they will encounter noncertified physicians in the hospitals and among the health plans in which they seek care for their children.

Policies and practices related to the role of board certification and recertification of pediatricians in hospital privileging.

CONTEXT: Privileging involves the granting of permission to perform specific professional activities under the jurisdiction of a governing body's (hospital) authority. In 1951, the Joint Commission on the Accreditation of Hospitals (later renamed the Joint Commission on Accreditation of Healthcare Organizations) was formed to codify the process of hospital assessment. In the early part of the 20th century, a parallel process was being undertaken by the medical specialties to evaluate and recognize competence among physicians through the creation of specialty boards. OBJECTIVES: To describe the use of board certification in hospital privileging policies for general pediatricians and pediatric subspecialists and to identify any variation among types of hospitals. DESIGN, SETTING, AND PARTICIPANTS: A telephone survey between January 1 and June 30, 2005, of privileging personnel among a random, weighted sample of 200 nonspecialty hospitals stratified by teaching status, children's vs general hospitals, freestanding children's hospital vs part of hospital system, and urban vs rural location. MAIN OUTCOME MEASURES: Proportion of hospitals that require board certification at initial privileging or at some point to maintain privileges and recertification to maintain privileges. RESULTS: Of 200 hospitals, 7 hospitals were ineligible because they did not have at least 1 pediatrician on staff. One hundred fifty-nine hospitals completed the telephone interview, resulting in an overall response rate of 82%. A total of 124 (78%) of 159 hospitals did not require general pediatricians to be board certified at initial privileging; however, 111 (70%) did require pediatricians to become board certified at some point during their tenure. Of these 124 hospitals, 52 (42%) did not report a time frame in which certification must be achieved. Forty-nine (43%) of 113 hospitals required pediatric subspecialists to achieve subspecialty certification within a specific time frame. CONCLUSIONS: These results raise issues regarding the manner in which board certification is used or not used by hospitals in their efforts to ensure the practice of high-quality care within their institutions. The premise for recertification is the need to assure the public of continued competence of physicians over the course of their professional careers. Increased attention by the public and regulatory agencies regarding patient safety and quality of care will likely have an impact on hospital privileging processes.