tients who arrive on time or late. For example, immunization cards are reviewed more often during unscheduled visits, but patient charts are more likely to be available for scheduled visits.

Dr. Fontanesi also emphasized the importance of reducing inefficiencies in office procedures to gain time for other tasks. Providers and staff may need to ask for more information from families to ensure that office records are accurate. He noted that parents are more likely to bring a child’s immunization record to a visit if they are specifically asked to do so. Dr. Fontanesi’s observations also showed that because of a lack of time or effective mechanisms, most practices missed the opportunity to assess when a child’s next immunizations were due. Improving the delivery of immunizations and other well-child care will require an adequate investment in the assessment of current office procedures and in tools and training to achieve greater efficiency and effectiveness.