TABLE A-1 Examples of Quality of Health Care in the United States—Underuse: Did Patients Receive the Care They Should Have Received?

Health Care Servicea

Sample Description

Data Source

Quality of Care




Childhood Vaccines

Three Polio; four Diphtheria, Tetanus, Pertussis; one Measles, Mumps, Rubella; and three Haemophilus influenzae type b (Hib) by 18 months old. (Three to four doses of Hib are recommended, depending on formulation; three Hepatitis B virus vaccines [HBV] are also recommended but were not included in this particular study.) (American Academy of Pediatrics [AAP], 1994; Centers for Disease Control and Prevention [CDC], 1995a).

Children 19–35 months old in 31,997 households from a nationally representative sample of the United States (U.S.).

National Immunization Survey (NIS), 1995.

74% received all the vaccines. (If three doses of Hib are not included, the percentage is 76%.)

CDC, 1997

Influenza Vaccine

Annual vaccination of all people≥65 years old is recommended (U.S. Preventive Services Task Force [USPSTF], 1989). This recommendation has since been reiterated (USPSTF, 1996).

Approximately 8,000 adults ≥65 years old from a sample of people representative of the U.S. civilian, noninstitutionalized population.

National Health Interview Survey (NHIS), 1993.

52% received annual influenza vaccine.

CDC, 1995b

Same as above.

From a sample of 7,997 randomly selected patients ≥20 years old who had visited a clinic during the

Mailed surveys with phone follow-up of patients who visited one of 44 clinics from August 1, to

72% of people≥65 years had an influenza vaccine in the prior year.

Kottke et al., 1997

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