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February 26, 1997

Systems Approaches and the Delivery of Health Services

Author Affiliations

From the Department of Preventive Care, Group Health Cooperative of Puget Sound, Seattle, Wash.

JAMA. 1997;277(8):670-671. doi:10.1001/jama.1997.03540320072039

In this issue of THE JOURNAL, LeBaron et al1 review a decade of work by the Georgia Department of Public Health to improve immunization levels in Georgia's public health clinics (more than 200) across the state.

The primary outcome of this very important work was a dramatic overall increase in immunization completion rates for 2-year-olds (the 4-3-1 series, where children receive 4 doses of the diphtheria-tetanus-pertussis vaccine, 3 doses of oral poliovirus vaccine, and 1 dose of measles-mumps-rubella vaccine) over a 7-year period, from 53% in 1988 to 89% in 1994. Incremental improvement in rates progressed in a moderately steady fashion, averaging about 6% per year. In addition, process measures also improved. These included fewer missed opportunities for immunization, fewer lost contacts with the children, and fewer late initiations of immunizations.

See also p 631.

The interventions in this study at the state level were to measure the immunization

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