Utilizing Immunization Registries in Local Public Health Accreditation

1
Utilizing Immunization Registries in Local Public
Health Accreditation

• Kevin Czubachowski
• Immunization Field Representative
• Michigan Dept. of Community Health
• Wendy Nye
• Supervisor, Region 4
• Michigan Childhood Immunization Registry

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Michigan Local Public Health Accreditation Program

• Development of the accreditation process
• Assessment Protocol for Excellence in Public
  Health (AFEXPH)
• Accreditation Steering Committee
• Primary steps in accreditation process
• Inclusion of registry related indicators

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Michigan Childhood Immunization Registry (MCIR)

• Established through Public Health Code
  requirement
• Tracks children birth to 20 years
• Providers required to record shots administered
  as well as histories
• Software development
• Access granted to registered users
• State divided into 6 regions

4
Accreditation the MCIR

• Focus on immunization/registry related indicators
• Assess where local health departments stand
• Work with local health departments and providers
  to clean up

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Registry-Related Indicators

• Assessments using registry data
• Semi-annual assessment reporting
• Age cohort 19 to under 36 months
• Over 50 for doses 4 DTaP, 3 Hib, 3 Polio, 1
  MMR, 3 Hep B, 1 Varicella
• Local healths role in registry
• Submits data within timelines
• Attends regional advisory board mtgs.

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Behind the Scenes Indicators

• IAP reports include immunization coverage levels
  (submitted semi-annually)
• LHD shows evidence of recall system
  collaboration with private providers
• Doses administered compliance reports for VFC
  participating providers
• Provider updates using registry news screen and
  newsletter

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Assess Local Health Department Status (County X)

• January 2002 County profiles ad hoc reports to
  identify areas of concern
• County profile 33 (48 w/o Varicella)
• Large pediatric provider not giving Varicella 9
  (83 w/o Varicella)
• Developed an action plan and presented to LHD to
  reach accreditation goals by July 2002

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Action Plan Activities

• Focus on children 12 to 31 months
• County-wide report listing children needing
  Varicella
• Drafted sent letter from the LHD asking for
  Varicella records
• Provider education for pediatrician
• Legacy data collection entry

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Cleaning Up

• Entered shot histories for 4 large volume
  immunization practices
• Utilized ad hoc reports to identify children with
  incorrect or no county field
• 813 letters sent (March 2002) 139 replies to
  region regarding Varicella history (return rate
  17)
• Identification of duplicates

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Clean Up Results

• April 2002
• County rate 38
• June 2002
• County rate increased to 43
• July accreditation visit
• County rate increased to 52

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Lessons Learned Benefits

• Increased county rates (spill-over)
• Better data quality
• Identified border providers
• Higher awareness of registry impact among data
  entry/management staff
• Stronger relationship with LHD

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Lessons Learned Barriers

• Buy-in from local health department and staff
• Provider relationships with local health
  department registry
• Organizational relationships
• Lack of staff training
• Technical issues
• Funding

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Registry Support for Accreditation

• Final question
• Has the accreditation process increased the state
  immunization rates and increased registry
  compliance?
• Final answer
• YES!!!

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Contact Information

• Kevin Czubachowski, MDCH Immunization Field
  Representative
• 810-985-9246
• E-mail CzubachowskiK_at_michigan.gov
• Wendy Nye, Supervisor, Region 4 MCIR
• 810-257-3562
• E-mail Wnye_at_co.genesee.mi.us