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Mary E. O'Connor, MD, MPH

Mary E. O'Connor is with Denver Health and Hospital and with 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).

My coauthors and I appreciate the comments of Stevenson et al. on our article "The Effect of Different Definitions of a Patient on Immunization Assessment." I agree with the vast majority of their comments. Our goal in this article was to make people aware that the use of a CASA assessment under the guidelines that are commonly used may not provide accurate information regarding immunization rates. After working in both public health and the private sector and working with the people who use CASA, I think part of the issue is that many people who are performing the CASA assessments may not be fully trained in all the ways the assessment may be customized. Without being fully trained, it is impossible for assessors and physicians to come up with appropriate guidelines for defining the patients to be selected and for defining missed opportunities.

There are many benefits of doing the CASA assessment. In our situation the Health Department was able to perform the assessment rapidly after we procured the charts. We were then able to use data from the assessment to fulfill other immunization audits. This can be a great benefit. However, unless the patient population is defined appropriately, one may get falsely low results. Most physicians will not be aware of the nuances of accurately defining their patient populations. My concern is that responsibility for the CASA assessment will, in many cases, be delegated to health care personnel who are excellent at reviewing charts and entering data but who may not have enough background knowledge to determine how to appropriately define the population and the criteria to be studied.

I think the flexibility of CASA is not well known. The people performing the CASA assessment must know all its capabilities, know its limitations, and know the choices that physicians can make in setting up their assessments. Such knowledge would enhance the positive features of the CASA assessment and would encourage its use.

This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by O'Connor, M. E. Search for Related Content PubMed Articles by O'Connor, M. E. Related Collections HIV/AIDS Prevention