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In both a local and national setting, provider prompts failed to improve adolescent immunization rates. More rigorous practice-based changes are needed.

Context-Although all children 6 months to 18 years are now recommended to receive influenza vaccine, the total direct and indirect costs for pediatric practices of delivering childhood influenza vaccination are unknown.Objective-To estimate nationally-representative pediatric practices' costs of providing influenza vaccination during the 2006-2007 season, and to simulate the costs pediatric practices might incur when implementing universal influenza vaccination for US children 6 months to 18 years.Design and Setting-We surveyed a stratified, random sample of New York State pediatric practices (n=91) to obtain information from physicians and office managers about all practice resources associated with provision of influenza vaccination. We estimated vaccination costs for two practice sizes (small, large) and three geographic areas (urban, suburban, rural). We adjusted these data to obtain national estimates. Conclusion-The total cost for pediatric practices to provide influenza vaccination is high, varies by practice characteristics, and exceeds average VFC reimbursement. Many pediatric practices may face financial risk unless both Medicaid and private vaccination reimbursement are increased. Main Outcome Measure(s)-Total

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