Cutler Institute for Health and Social Policy

Population Health and Health Policy

First Steps Phase I Initiative: Improving Immunizations for Children and Adolescents


This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine's Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement.

Background: Through the Improving Health Outcomes for Children (IHOC) grant, Maine Quality Counts is leading the First STEPS (Strengthening Together Early Prevention Services) Learning Initiative to support Maine’s primary care practices in improving preventive and screening processes for children and building medical homes. The First STEPS Learning Initiative is being implemented in phases, with the first phase (September 2011 - August 2012) focusing on improving immunizations for children and adolescents. As part of the initiative, IHOC identified specific immunization measures to be improved. First STEPS provides wide-ranging and in-depth quality improvement, coaching, andata monitoring of standard quality measures, and educations support to pediatric and family medicine practices as they continue to enhance health outcomes for children. The goal of Phase I was to improve immunization rates in participating practices by at least 4 percentage points within one year of project initiation by implementing changes in office procedures advocated by the American Academy of Pediatrics’ Bright Futures curriculum.

Suggested Citation: Fox K, Gray C. First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents. Portland, ME: University of Southern Maine, Muskie School of Public Service; March, 2013. Improving Health Outcomes for Children (IHOC) Final Evaluation Report.

Publication Type: 
Publish Date: 
March 1, 2013

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Dr. Ziller to speak on Rural Implementation and Impact of Medicaid Expansions

The impact of the ACA Medicaid expansion on health care coverage and access in rural areas is largely unknown and will depend on the different state policy contexts in which the expansions are implemented and on existing system capacity. Understanding how many rural residents are likely to become newly eligible for Medicaid under the ACA, as well as their characteristics and health status, will provide important information to aid policymakers in structuring outreach and enrollment strategies and ensuring that the healthcare infrastructure and delivery systems in rural areas can address the needs of these individuals.

On March 18th, Dr. Ziller, Deputy Director of the Maine Rural Health Research Center at the University of Southern Maine, will present via a SHARE webinar, nationally representative information identifying rural-urban differences among low-income non-elderly adults (18 to 65) in the following areas:

  • Medicaid eligibility, pre-ACA
  • Medicaid participation, pre-ACA
  • New Medicaid eligibility in 2014

Dr. Ziller will also analyze the characteristics associated with any rural-urban differences in the above areas. Characteristics to be considered include age, gender, employment, education, income, Census region, health status, current relationship to primary care provider, primary care supply, and FQHC availability.

This webinar is based on Dr. Ziller's research under a State Health Access Reform Evaluation (SHARE) grant to inform federal and state implementation of the ACA Medicaid expansion by estimating the size and characteristics of the rural population likely to be newly eligible.
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