Blue Care Network Best Practices

Adolescent immunizations

Ann Arbor practice uses electronic medical records and parent education to maintain high adolescent immunization rates

Dr. Dumont examines Aaron Brown

Immunization rates for adolescents have historically lagged behind those of childhood immunizations. According to the American Academy of Pediatrics, about 35 million adolescents failed to receive at least one recommended vaccination.

The Centers for Disease Control and Prevention and the Advisory Council on Immunization Practices guidelines for immunizations recommend that preadolescents 11 to 12 years old receive a single dose of Tdap or a Td booster (with a move toward phasing out the Td booster) and an MCV4 or MPSV4 vaccine.

Allen Dumont, M.D., who practices in Ann Arbor, has established a high rate of adolescent immunizations by using electronic medical records and establishing office policies to identify missing immunizations. It’s important to the practice because about 30 percent of its patients are adolescents.

Allen Dumont, M.D.

One of the barriers to immunizing teens is that they may not come in for visits. However, Dr. Dumont's office treats many school athletes. A physical is generally required, so the office staff uses those visits as an opportunity to immunize their teen patients. “The athletic form usually asks about a tetanus shot, so everything else falls into place,” Dr. Dumont says.

“When patients come to our office, the receptionist uses an encounter sheet and notes any gaps,” says Dr. Dumont. The office also checks its electronic medical records and the doctor treating the patient will validate its accuracy. “The system works when you are motivated and everyone does their job,” he says.

“When patients come to our office, the receptionist uses an encounter sheet and notes any gaps,” says Dr. Dumont. The office also checks its electronic medical records and the doctor treating the patient will validate its accuracy. “The system works when you are motivated and everyone does their job,” he says.

Dr. Dumont says his office has seen more adolescent patients due to state immunization requirements. Schools are reporting immunizations and it forces the parents to bring their teens in to update their inoculations, he notes.

The pediatric office also has a person who is dedicated to tracking HEDIS® data, says Dr. Dumont. “We get reports from several insurance companies. Then we contact the patients.”

It's also an ongoing education process with the staff. The doctors and staff meet monthly to talk about many issues, including vaccines. The three doctors and two nurse practitioners discuss cases where the practice could improve.

Patient education dispels fears

One of the challenges with immunizations is the belief some parents have that immunizations can cause complications. “That takes the most amount of time for us to deal with,” says Dr. Dumont. “We probably convert two out of every 10 people. ”Dr. Dumont says that even though the office is located in a fairly intelligent community, “Sometimes people may look at research data and interpret it incorrectly.”

How does he address that? “I ask them for their reasons and I can bring up scientific data to prove them wrong without belittling them. I get them into a conversation where they have to be analytical rather than emotional. I recently spoke to a dad from Arizona. I talked to him about the potential risks of not getting vaccinated. He had to go home and digest it.”

The toughest converts are often those who know someone who claims to have been injured by a vaccine, Dr. Dumont says. “I attend a vaccine conference every year, so I can always show statistics that counter their arguments.”

Being in practice a long time also helps. “I can also say that I am old enough to have seen all the diseases that some newer doctors haven't seen. I can relate some horror stories,” he says.

But sometimes personal experience is the ultimate persuader.

“I had a patient who claims her uncle got vaccinated in the army during World War II and never recovered from a complication,” says Dr. Dumont. “The mother has seven children and wasn't going to vaccinate any of them. Then one day she had to take four kids to the emergency room with 105-degree fevers and chicken pox. After she experienced that, she finally got all her kids immunized.”

HEDIS measure: Adolescent immunizations

Adolescents who turn 13 during the measurement year

Percent of fully immunized 13-year-olds

  • One meningococcal vaccine between 11th and 13th birthday
  • One TD or Tdap on or between 11th and 13th birthday 

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