BOOKS OF RtfiDIfGS - PAHO/WHO

Vi. .XIX, No. 3
- 129 -
tom' s recognition of and response to patients
presenting when due for follow-up
services, rather than the utilization behIavior
of the patient population. Table 2
illustrUtes lhow data for several tracers can
¡)e aggregated for a single function, and for
sequential events within that function. It
also il>lustrates that the results are not alwuays
similar across tracers. For cxamplc,
the fact that lacerations, with sutures acting
as an apparent clinical sign calling for attention,
produced higher recognition and a
ver)' different pattern than the other tracers,
suggests that it may be possible to devise
more efficient ways of aggregating
across tracers or to categorize health conditions
in a way that allows for more representative
sets of tracers to be selected.
In order to examine the performance of
Ciflerent system components by funetion,
the assessment often employs a
population-based indicator in conjunetion
with an encounter-based indicator that is
disaggregated by relevant system components
as well as by function. Table 3 shows
the data examining infant immunization in
a rural private practice setting, two Service
Units of the IHS and a large closed-panel
PERFOR.\MANCE ASSESSMENT
health maintenance organization. The
population-based immunization rate expresses
the percentage of infants who had
received three DPT and two polio immunizations
by 12 months of age. The
encounter-based immunization rate expresses
the percentage of visits by infants
due for an imniunization in which the immunization
was provided. The DPT immunization
was considered to be due at 2
months of age and to be repeated monthly
until three doses had been given. If, at the
time of a visit, the infant had a rectal temperature
greater than 100.5 ° , then an immunization
was not considered due on that
visit.
Among the infant population served by
the private practict, only 32 per cent had
received three DPT and tho OPV' immunizations
by age 12 months and the
encounter-based indicator revealed that
immunizations were provided on only 22
per cent of the visits for which they were
due. This private practice had assumed
-.. hat infants were receiving their immunizations
from the nearby county health
clinic. But when the encounter-based indicator
was sorted by the physician's office
TABLE 3. Data for Infant Immunization From a Rural Private Practice,
Two IHS Service Units, and One Health Maintenance Organization (HMO)
llustrating the Performance Patterns Resulting From the Assessment Method
Private
Practice IHS-A IHS-B HMO
Immunization rate
(population-based) '2% (26150) 86% (43/50, 56% (28/50) 58% (29!50)
Immunization rate
(encounter-based) 22% (63/285) 46% (179/387) 38% (119/316) 86% (127/147)
Sorted by facility
Medical officer 19% (211112)
County clinic 24% (42/173)
MCH clinic 85% (103/121)
General clinic 34% (70/208)
2 fild clinics 11% (6/53)
Inpatient service 0% (015)
Sorted by provider
discipline
Physician 34% (64/189)
Physician extender 75% (36/48)
Clinic nurse 50% (6/12)
Public health nurse 87% (13/15)
Pharmacist 0% (0/52)