practices by developing methods and technologies (e.g., software or analytical services) that providers can use for procedures such as chart audits and patient tracking.

  • Simultaneous administration of vaccines. Incentives are needed to encourage providers to follow the CDC standard calling for simultaneous administration of all medically indicated vaccines at one visit. Medicaid reimbursements, for example, could be adjusted to favor simultaneous administration of vaccines or use of combination products such as the measles-mumps-rubella vaccine over single-antigen products.

  • Collaboration between the public and private sectors. Providers from both the public and private sectors are needed to deliver immunization services. Health departments can promote better services for their communities by developing good working relationships with private providers. Official health department representatives for immunization services can work with all providers to resolve problems and promote practices consistent with the CDC standards. Committee member Fernando Guerra noted the success that San Antonio has had with this approach and suggested using IAP funds to support such representatives.

  • Participation in patient follow-up. New approaches to patient follow-up may involve the participation of additional health care providers in immunization services. Hospitals, for example, can ensure that the children born in their facilities have an appointment for their next immunizations before they leave the hospital. Hospitals can also follow up later to determine whether those children have actually received the appropriate immunizations. The NVPO has discussed such activities with the Catholic Health Association.

  • Immunization practices bibliography. A comprehensive and annotated bibliography of studies on immunization practices would be of value to providers, policymakers, and researchers. Assembling published and unpublished studies of barriers to immunization and interventions to improve immunization coverage would help identify issues of special concern (e.g., missed opportunities for immunization) and suggest solutions (e.g., improving provider education about true contraindications to immunization).

Steps to Take in the Longer Term
  • Prevention curricula in professional training. Academic health centers can improve their education about immunization as part of a broader effort to improve education on all aspects of preventive health care. As vaccine-preventable diseases become less common, training programs must prepare providers to recognize these diseases when they do occur. Academic programs

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