Comparing Vaccine Providers Effect on 43133 Immunization Rates

Comparing Vaccine Providers: Effect on 43133 Immunization Rates for American Indian/Alaska Native (AI/AN) Children in Arizona Scott Hamstra, MD Indian Health Service, scott. hamstra@hhs. gov Kimiko Gosney & Michael Conklin Arizona Department of Health Services CONKLIM@azdhs. gov

Background - ASIIS • Arizona State Immunization Information System (ASIIS) started in 1998 • Majority via Vital Records (birth certificate) • State law requires licensed providers to report • Estimated ~95% of providers in AZ report • Electronic Data exchange with IHS and tribal sites began in 2004, with earnest in 2005

Background – AI/AN • AI/AN make up 6 -7% of the population in AZ for 19– 35 month olds ~9, 572 (2006 census) • 22 IHS or tribal facilities in Arizona • Sites submit quarterly 43133 immunization rates on 19 -35 month olds to IHS • 16 IHS and tribal facilities currently submitting data to ASIIS electronically

Arizona counties and reservations

Background • Before ASIIS existed AI/AN vaccine rate (19 -35 months) reported by – local Indian Health Service sites – and the National Immunization Survey (NIS) • Today, ASIIS – provides new opportunities to examine data and gain new insights into AI/AN vaccines rates

Objectives – Use ASIIS data • To determine who provides vaccines to AI/AN children • To determine if provider choice affects 43133 coverage for AI/AN children * Prompted by “discovery” of multiple vaccine providers for some AI/AN children

Methods • All children 19 - 35 months old (on 12/31/05) in ASIIS identified as AI/AN • Compared 43133 series completion rate by provider type • Provider type categories – IHS, Private, Public, & combinations * Medical Home = all vaccines from one provider

ASIIS ---- 19 -35 month olds • 6. 5% identified as AI/AN within ASIIS = 9, 148 • 2006 AZ census projection = 9, 572 Bottomline: ASIIS = 96% of census, therefore = reliable denominator

AI/AN 43133 vaccine rate ASIIS vs. NIS and IHS • IHS sites report = 81% • NIS report = 79% ASIIS data • IHS only sites = 82% • AI/AN overall rate = 78% Bottomline: consistent reliable data

Provider Types Where do AI/AN get vaccines?

Provider Types - Medical Home 59% 4451 454 448

AI/AN 43133 rate by Provider Type 80% 43133 Goal

AI/AN 43133 ASIIS rates IHS vs No IHS Vaccine Provider 82% 57% of total 6498 of total 1355 Combined rate = 78%

Factors impacting IHS rates • IHS uses a state-of-the-art Immunization software package with … – Forecasting – Point-of-Care data entry – Patient Tracking & Automatic Due Letters – Community Quarterly Reports with patient lists • Public Health Nursing on reservations • Electronic Data export

Conclusions • The Arizona State Immunization Information System (ASIIS) has reliable data that can be examined in previously unavailable ways. • ASIIS demonstrates that more than ½ of AZ AI/AN children use multiple vaccine providers • AI/AN children who get vaccine at any IHS site have high 43133 rates • AI/AN children who use a Single Vaccine Provider have LOWER 43133 completion rates than those who use multiple providers