Providing VFC Accountability via Linkage with Immunization Registry

Providing VFC Accountability via Linkage with Immunization Registry New York City Department of Health and Mental Hygiene Bureau of Immunization 40 th National Immunization Conference Atlanta, GA March 7, 2006 Michael Andreas Hansen, MPH, Shirley Huie, MPH, Vikki Papadouka, Ph. D, MPH, Ronda Zawel, MSW, Amy Metroka, MSW, Dileep Sarecha, MBBS, MPH and Jane R. Zucker, MD, MSc.

New York City Background • Population: 8. 2 million • Annual birth cohort of ~124, 000 • 65% of children VFC-eligible • High mobility of the population within the city • Child immunizing sites ~1, 500 • Number of pediatric practitioners estimated to be >5, 000 • 77. 2% vaccine coverage rate for 4: 3: 1: 3: 3: 1 (National Immunization Survey, 2004)

Citywide Immunization Registry (CIR): Background • Mandatory reporting of immunizations administered to children • Birth to < 8 years old since January 1, 1997 • Birth to < 19 years old since August 18, 2005 • 2. 5 million records and over 21. 4 million immunization events • Birth certificates loaded weekly

CIR Status • Reporting Compliance: • 100% of public sites report (81/81) in last 6 months • 74% of private sites report (904/1226) in last 6 months • Registry Completeness: • 72% of children age 6 mo - 6 yrs have 2 or more immunizations in CIR • Average of 14. 7 immunizations per 2 year old child • Captures ~ 75% of immunizations given

NYC Vaccines for Children Program (VFC) • 1, 301 Sites • 81 public • 1220 private • 2. 5 million vaccine doses distributed in 2005 • 12, 000 orders in 2005 ~ 48 orders / workday • 361 (28%) sites visited in 2005 • Vaccines given only for VFC-eligible children (non -universal project)

Objectives • Increase accountability of VFC purchased vaccines • Reduce paperwork for provider and VFC staff • Increase CIR completeness • Develop provider profile to improve interactions with providers

Doses Administered Report (DAR) • Currently required to order VFC vaccine • Self-reported by provider of aggregate doses Problems • Time consuming for provider to complete • Time consuming for VFC staff to manually enter data into VACMAN database • Data non-verifiable – aggregate reports do not permit program audit • Duplicative process – providers report similar information to Health Dept. via CIR

Expansion of CIR: An Opportunity • Barrier to using CIR to produce DARs was that providers were only required to report vaccines given to children < 8 years • August 2005: NYC Health Code mandate for reporting to CIR was amended to include all individuals < 19 years • Urged providers to include VFC-eligibility status when reporting to CIR • Added VFC eligibility status field to online registry

Method: Notify Providers • Letter sent to all providers on 01/17/06 announcing transition to accepting only CIR-generated DARs starting 09/01/06 • VFC vaccine shipments will be based on number of doses reported to CIR • Letter distributed in numerous ways: • • • Certified mail to all VFC providers Mailed to all CIR Facilities E-mailed to all CIR contacts Included in all VFC shipments Broadcasted citywide through the Health Alert Network

Method: Linking Vacman & CIR database • VFC pin & CIR Facility Code • Each VFC pin must be matched to one CIR Facility Code • Correct matching essential to comparing: • # of VFC vaccine doses shipped • # of doses reported to CIR

Match Database – Main Page Start with VFC pin #

Match Database – CIR Facilities Identify possible CIR Facility Code match

Match Database – Main Page Call Provider

CIR Generated DAR: Network

CIR Generated DAR: Group

CIR Generated DAR: Facility

Results As of 02/10/06 • Linking: • 65% of VFC pins matched to CIR codes (850/1301) • Reporting for VFC pins linked to CIR facility codes: • 71% of VFC doses were reported to CIR • 27% of sites report > 90% of VFC doses to CIR • 13% of sites report > 75 to < 90% • 18% of sites report > 50 to < 75% • 42% of sites report < 50%

Anticipated Benefits • Providers: • Reduce record keeping and paperwork • Eliminate duplicate reporting • Identify problems in electronic record keeping • VFC: • Improve validity of Doses Administered Report • Reduce time spent entering data • Reduce time spent managing incoming faxes • CIR: • Recruit providers who receive VFC vaccine but do not report to CIR • Collect more complete immunization data • Update existing provider demographics

Conclusion • Linking Registry and VFC databases • is feasible • will provide Bureau the ability to target providers that need assistance more efficiently • demonstrates program responsiveness to provider requests to eliminate duplicative reporting