Status of Quality Improvement Activities to Improve Immunization Practices and Delivery: Findings From the Immunization Quality Improvement Symposium, October 2003 Abigail Shefer, Jeanne Santoli, Pascale Wortley, Vickie Evans, Nancy Fasano, Alan Kohrt, John Fontanesi, and Peter Szilagyi  T he Centers for Disease Control and Prevention convened a symposium on 22–23 October 2003 to bring together investigators and stakeholders working to apply the quality improvement (QI) approaches to immunization delivery in individual medical practices. The goal was to identify effective program components and further development of model programs. A call for projects was widely disseminated; of 61 submissions received, eight projects were selected. Three of the eight programs used the “train the trainer” approach, three used site-specific training, one used a “practice collaborative” approach, and one employed the use of tracking and outreach workers to effect change. At the symposium, invited experts reviewed each program. Common program features that appeared effective included involvement of a variety of staff within the office environment, collection and review of site-specific performance measurements to identify gaps in delivery, periodic monitoring of performance measurement to revise interventions and maintain the improvements, and provision of formal continuing education credits. While research is needed on ways to promote and integrate QI into practices, it is likely that a variety of QI strategies will be shown to be effective, depending on the clinical settings. The field will benefit from standardized outcome measures, cost analysis, and evaluation, so comparisons can be made among different programs. KEY WORDS: immunization, quality improvement J Public Health Management Practice, 2006, 12(1), 77–89 C  2006 Lippincott Williams & Wilkins, Inc. Delivery of immunizations for children has been increasing, yet today only 79 percent of 2 year olds are fully immunized 1 ; immunization rates for ado- lescents (Centers for Disease Control and Prevention [CDC], unpublished data, 2003) and adults are even lower. 2 Rates for other preventive services for children 3 (eg, anemia, tuberculosis, and lead screening) and adults 4,5 (eg, colonoscopy, mammography) are also low, and studies have noted that patients receipt of The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency. Authors thank Mary McCauley for her help in editing. Corresponding author: Abigail Shefer, MD, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop E-52, Atlanta, GA (e-mail: ams7@cdc.gov).  Abigail Shefer, MD, is Chief, Health Services Research & Evaluation Branch, National Immunization Program, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia. Jeanne Santoli, MD, MPH, is Deputy Director, Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia. Pascale Wortley, MD, MPH, is Medical Officer, National Immunization Program, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia. Vickie Evans, BS, is Team Leader, National Immunization Program, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia. Nancy Fasano, MA, is Program Operations Branch Chief, National Immunization Program, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia. Alan Kohrt, MD, is Chief Quality Officer, Children’s Healthcare of Atlanta, Atlanta, GA. John Fontanesi, PhD, is Professor of Pediatrics, Division of Community Pediatrics, University of California, San Diego. Peter Szilagyi, MD, MPH, is Professor of Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York. 77