Immunization Registry Targeted Research Project

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MISSOURI DEPARTMENT OF HEALTH
IMMUNIZATION REGISTRY TARGETED RESEARCH PROJECT
GRANT U1W/CCU714725
Nancy L. Hoffman, R.N., M.S.N. Deputy
Director Center for Health Information
Management and Epidemiology
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Research Question
How effective and feasible is it to adapt an
existing billing and/or patient management system
to obtain accurate and complete immunization
information for entry into a registry?
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• Key Elements
• MOHSAIC Central Registry
• Birth Records
• State Law
• Experience in Data Linkage

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Procedures

• Standard Data Format for Data Transmission
• Probabilistic Matching using AutoMatch by
  Matchware
• Deterministic Matching
• Effects of Mothers Information
• Quality and Completeness of Medicaid Billing
  Data

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DSS Medicaid billing data
DSS Client Numbering System
DOH Birth/Deaths/ Adoptions Demo
graphics Hepatitis B
Electronic encounter/ billing data
MOHSAIC Central Register
DSS Eligibility Data
DOH WIC Client Demographics
DSS Managed Care Plan/Provider Agreement
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Registry Status Clients enrolled 1,117,022 Cli
ents with vaccine(s) 723,899 Doses of
vaccine recorded 6,424,313
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Source and Number of Records Submitted for
Probabilistic Matching
91.2
84.8
80.7
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Source and Number Records Submitted for
Probabilistic Matching Childrens Mercy
Total Matched Hospital
7,692 6,520 Care Partners
3,190 2,573 Medicaid Billing
34,666 31,598
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Medicaid/CASA Billing Data Validation
Criteria Children born April 1, 1996 - June
30, 1996 Medicaid eligible Vaccine dates in
MOHSAIC
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Medicaid/CASA Billing Data Validation

• Abstracted and merged Medicaid billing data
  with MOHSAIC
• Completed CASA assessment for private
  providers
• Compared clients in CASA with MOHSAIC
• Identified if client Medicaid eligible - if Yes
• compared CASA dates to MOHSAIC dates
• documented differences

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Medicaid/CASA Billing Data Validation
Client Records Reviewed 1,019 Client Records
Meeting Criteria 143 Total Number Vaccine Doses
2,112 Percent vaccines in both
CASA MOHSAIC
63 Percent vaccines only in MOHSAIC
22 Percent vaccines only in Physicians 29
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Missouri 's Medicaid Enrolled Children 24-35
Months Old
D470 vaccine doses in MOHSAIC A1504
F 2112
Total number vaccine doses
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Key Issues

• Billing Data Must Be Filtered
• Billing Data Incomplete
• Timeliness of Data
• Inconsistent Coding Practices
• Data Exception Handling Cost
• Prohibitive
• National/Multi State Data Systems
• Ability to Include DOH Unique
• Identifier in Billing/Management
• System

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Conclusions

• Probabilistic matching seems to have only
• marginal value over deterministic matching
• Inclusion of maternal information
• increases the match rate
• Billing data often incomplete and not timely
• Billing data includes only vaccines given
• during visit - lacks historical doses
• Medicaid billing data expanded the registry
• Can not rely just on billing data