We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Effect of the Vaccines for Children Program on Inner-city Neighborhood Physicians

Gerry Fairbrother, PhD; Stephen Friedman, MD, MPH; Karla L. Hanson, PhD; Gary C. Butts, MD
Arch Pediatr Adolesc Med. 1997;151(12):1229-1235. doi:10.1001/archpedi.1997.02170490055010.
Text Size: A A A
Published online


Objective:  To determine the probable effect of the Vaccines for Children (VFC) program on immunization coverage.

Design:  Preintervention and postintervention study design, with data collected before and after enrollment in the VFC program.

Setting:  Twenty-three inner-city neighborhood physicians' offices in New York City.

Participants:  In 1993,30 physicians were randomly selected from 8 neighborhoods with the highest proportions of Medicaid-eligible individuals in New York City. In 1995-1996, the 30 physicians were contacted again. Twenty-three agreed to an interview and medical record review. Within each office, the medical records of children aged 3 to 35 months, with at least 3 visits in a 3-month or longer period, were randomly selected. Medical record reviews were conducted for 173 eligible children in 1993 and 528 in 1995-1996.

Interventions:  The VFC program was implemented in October 1994. The administration fee increased from $2 to $17.85; physicians received vaccines free.

Main Outcome Measures:  Up-to-date status for immunizations and lead and tuberculosis screening; percentage of visits that are missed opportunities to immunize; and percentage of visits that were well-child visits. Up-to-date status, missed opportunities to immunize, and well-child visits were compared across time using χ2 analysis, corrected for the use of cluster sampling.

Results:  Up-to-date status changed significantly before and after enrollment in the VFC program (P<.05) for all immunizations and for lead and tuberculosis screening. For the diphtheria toxoid, tetanus toxoid, and pertussis vaccine, oral poliovirus vaccine, and measles, mumps, and rubella vaccine combined, coverage increased from 17.9% to 42.2%, up by 24.3 percentage points (P<.05). Missed opportunities to immunize did not change, but well-child visits increased from 15.0% to 21.6% (P<.05). Physicians generally attributed performance improvements to the VFC program and not to other competing hypotheses.

Conclusions:  The VFC program seems to be responsible for an increase in immunization rates among these physicians.Arch Pediatr Adolesc Med. 1997;151:1229-1235.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.