1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs.
2. Read the articles carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.
3. The following quiz questions have been designed to provide a useful link between the CME articles in the issue and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME REGISTRATION FORM at the end of the quiz. Retain a copy of your answers so that they can be compared with the correct answers should you choose to request them.
4. Type or print your full name and address and your date of birth in the space provided on the CME REGISTRATION FORM.
5. Complete the evaluation portion of the CME registration form. Formi end quizzes cannot be processed if the evaluation portion is incomplete. The evaluation portion of the CME registration form will be separated from the quiz upon receipt at PEDIATRIC ANNALS. Your evaluation of this activity will in no way affect the scoring of your quiz.
6. Send the completed form, with your S25 payment (check, money order, or credit card information) to: VINDICO MEDICAL EDUCATION, PO Box 36,Thorofare NJ 06066. Payment should be made in US dollars drawn on a US bank.
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8. Be sure to mall the CME registration form on or before the deadline listed. After that date, the quiz will close. CME registration forms received after the date listed will not be processed.
This CME activity is primarily targeted to pediatricians, ostéopathie physicians, pediatrie nurse practitioners, and others allied to the field. There are no specific background requirements for participants taking this activity. Learning objectives are found at the beginning of each CME article.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Vindico Medical Education and SLACK Incorporated. Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.
Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™, Physicians should only claim credit commensurate with the extent of their participation in the activity.
FULL DISCLOSURE POLICY
In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.
UNLABELED AND INVESTIGATIONAL USAGE
The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.
Questions 1 through 6 are taken from the article "Improving Immunization Rates in Practice Settings" by Christopher Rizzo, MD, FAAP (see pages 493-497).
1. Elementary school entry requirements for Immunization:
A. Are unnecessary.
B. Have no effect on immunization rates in school-aged children.
C. Lead to greater than 95% immunization rates in 2-yearold children.
D. Alone do not prevent disease outbreaks.
2. The 1989-1991 measles resurgence in the United States led to all of the following except:
A. The creation of the Vaccines for Children (VFC) program.
B. Promotion of immunization coalitions and registries.
C. The National Vaccine Injury Compensation Program.
D. Efforts to ensure more infants and children are immunized on time.
3. All of the following are proven strategies to raise immunization rates in clinical practice except:
A. Creating a reminder/recall system.
B. Giving no more than two injections per visit.
C. Improving convenience for patients.
D. Measurement and feedback to providers.
4. Which of the following is a National Vaccine Advisory Committee (NVAC) Standard for child and adolescent immunization practices?:
A. Limit vaccine administration to no more than four injections per visit.
B. Assess immunization status at every patient visit.
C. Defer immunization for children with mild illness.
D. Administer immunizations only during primary preventive visits.
5. All of the following are true of reminder/recall systems except:
A. They remind patients that a vaccine is due or coming due.
B. They must be computerized systems.
C. They recall patients behind on immunizations.
D. They are available as a part of an immunization registry.
6. All of the following are true regarding use of combination vaccines except:
A. They can only be given during preventive visits.
B. They lead to increased immunization rates.
C. They reduce the number of injections for patients.
D. The single administration fee is a disincentive for providers.
Questions 7 through 11 are taken from the article "Using a Registry to Improve Immunization Delivery" by Steven W. Kairys, MD, MPH; Ruth S. Gubernick, MPH; Adrienne Millkan; and William G. Adams, MD (see pages 500-506).
7. Immunization registries provide all of the following except:
A. Immunization data on all children.
B. Ability to print records for schools, daycares, camps, and soon.
C. Ability to determine insurance eligibility.
D. Reminder/recall capability.
8. Physician perceived benefits of a registry include all of the following except:
A. Data on community-wide immunization rates.
B. Ability to print forms.
C. Ability to give patient education materials.
D. Ability to review individual patient records.
9. The number of states with active community-based immunization registries is:
10. Office-based changes necessary to promote acceptance and use of registries include: A. A state law mandating use of a registry.
B. Physician CME programs.
C. Interventions that incorporate the entire office staff.
D. Managed care organization pressure to change using pay-f or-performance measures.
1 1 . Methods to increase use of immunization registries in the primary care setting include all of the following except: A. Make entering data a nursing responsibility.
B. Ensure electronic transfer of information to and from the registry.
C. Enter immunization data at the point of service.
D. Pay staff overtime to input data.
Questions 12 through T6 are taken from the article "Coding and Payment for Immunizations" by Richard H. Tuck, MD, FAAP (seepages 507-512).
12. An 18-month-old child returns for a catch-up DTaP vaccine after missing the vaccination at her well-child visit due to an illness. She is seen by your nurse and immunized. The correct code for the immunization administration is: A. 90471. B. 90473. C. 90465. D. 90467. 13. Immunization administration codes include all of the following except: A. Preparing and handling the chart.
8. Presenting the Vaccine Information Sheet (VIS).
C. Evaluation and management services.
D. Medical supplies, including syringes and needles.
14. For your nurse to bill a 9921 1 visit with an immunization administration service, all of the following are necessary except:
A. The nurse must provide a separately identifiable evaluation and management service.
B. The physician must be directly available in the same room.
C. The nurse must completely document the visit.
D. The nurse and physician must sign the visit documentation.
15. Which of the following statements regarding vaccine costs are true?:
A. Vaccine costs typically are based on the average wholesale price or the average sales price.
B. Vaccine acquisition costs are adjusted monthly by payers.
C. Pediatricians have no control over vaccine costs and payment issues except through collective bargaining with government payers.
D. None of the above.
16. According to the American Academy of Pediatrics, for a medical home to make delivering vaccines economically feasible, the vaccine price charged to the insurer should exceed the vaccine purchase price by:
A. 10% to 15%.
B. 17% to 28%.
C 35% to 50%.
D. At least 50%.
Questions 1 7 through 20 ore token from the article "Linking Practices with Community Programs" by Christopher Rizzo, MD, FAAP (see pages 51 3-51 5).
17. The National Vaccine Advisory Committee standards for child and adolescent immunization practices include which of the following?:
A. Pediatricians should provide vaccines in schools.
B. Pediatricians should make home visits to children with delayed immunizations.
C. Healthcare professionals should practice with community-wide protection from vaccine-preventable diseases in mind.
D. None of the above.
18. All of the following groups of children should receive case management for immunizations except:
A. Children with a history of a vaccine-preventable disease.
B. Children exposed at birth to a mother with hepatitis B.
C. Children with delayed vaccinations who do not respond to recall efforts.
D. Children with delayed vaccinations who have transportation problems.
19. The percent of children who receive at least one extra unnecessary vaccine is:
20. All of the following are the roles of vaccine coalitions except:
A. They generate funding from sources other than healthcare providers.
B. They provide well-child care services.
C. They perform social marketing to increase awareness.
D. They assist providers with entering historical data into registries.