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Mary E. O'Connor, MD, MPH, Barbara Maddocks, LPN, Cindie Modie, RN and Heather Pierce, BA

At the time of the study, all authors were with the Cuyahoga County Board of Health, Cleveland, Ohio. Mary E. O'Connor was also with Rainbow Babies and Childrens Hospital and Case Western Reserve University, Cleveland, Ohio; she is now with Denver Health and Hospital and the Department of Pediatrics, University of Colorado Health Sciences Center, Denver.

Correspondence: Requests for reprints should be sent to Mary E. O'Connor MD, MPH, Westside Family Health Center, 1100 Federal Blvd, Denver CO 80204 (e-mail: moconnor{at}dhha.org).

Objectives. In this report, the authors compare immunization assessment using 2 definitions of a patient.

Methods. Two Clinical Assessment Software Application (CASA) assessments were performed. The first sampled 200 two-year-olds seen at least once since birth. The second sampled 200 two-year-olds seen in the previous year. Children with incomplete immunizations in the first sample were contacted.

Results. In the second sample, 72% of children had complete immunizations, compared with 46% in the first sample. In the first sample, 78% of children with incomplete immunizations had not been seen during the past year. Of 134 children in the first sample seen in the past year or successfully contacted, 75% had complete immunizations.

Conclusions. The CASA assessment's definition of a patient underestimates immunization rates.

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