Hello, 
 
I am a General Pediatrician and a Pediatric Infectious Disease Specialist at Eau Claire Cooperative Health, SC. I have been working on improving Childhood immunization in kids 2 years and younger and found out that some gaps are unfairly counted only due to the fact that patients showed up few months late and 1) either satisfied their needs based on a catch up schedule (such as PCV and HIB) approved by ACIP and CDC 2) or either did not qualify for a certain vaccine given the age limit for certain vaccines (such as Rotavirus).
 
If the goal of studying the gap is to improve what a provider can do during a "qualifying visit", then our measure needs to be adjusted to meet ACIP qualification for each vaccine and based on patients' age during each visit.

CMS117V10

Measure description: 

Prevnar and HIB vaccination can be satisfied if given in fewer doses for those kids who show up late (for example immigrants) based on a catch up schedule. 
 
-Rotavirus:
Rotarix requires 2 doses: 1st dose can only be given between 6 weeks and 15 weeks. And 2nd dose can't be given after 24 weeks. That means if patient starts coming to us after 15 weeks of age for first dose or after 24 weeks for 2nd dose, it will show as a gap although patient did not actually qualify for it.
 
Rotateq requires 3 doses: 1st dose can only be given between 6 weeks and 15 weeks. And last dose of RotaTeq can't be given after 32 weeks. That means if patient starts coming to us after 15 weeks of age for first dose or after 32 weeks for last (2nd or 3rd) dose, it will show as a gap although patient did not actually qualify for it.
 
Further, the actual wording of rotavirus might not capture all the gaps because it does not look for a total of 3 for Rotateq, but says 2 or 3 for rotavirus vaccine.

 
Solution:
 
Suggested new wording / new measure: 
-PCV would count as satisfied if patient receives: same wording as we have now and add it to: "OR 2 doses 8 weeks apart between 12mo and 24mo". 
 
-HIB would count as satisfied if patient receives: same wording as we have now and add to it: "OR 2 doses 8 weeks apart between 12mo and 24mo OR 1 dose between 15mo and 24mo".
 
Rotavirus vaccine would count as satisfied if patient receives:
Rotarix:
-2 doses 4 weeks apart between 6 weeks and 24 weeks
-OR 1 dose between 6 weeks and 15 weeks AND no visit between (1st dose + 4weeks) and 24mo
-OR no visit between 6 weeks and 24 weeks
 
"Rotateq:
-3 doses 4 weeks apart between 6 weeks and 24 weeks
-OR 1 dose between 6 weeks and 15 weeks AND no visit between (1st dose + 4weeks) and 32 weeks
-OR 2 doses between 6 weeks and 32 weeks AND no visit between (2nd dose +4 weeks) and 32 weeks-OR no visit between 6 weeks and 32 weeks.