Improving Reporting andIIS-Based Coverage byConducting VFC AccountabilityThrough an IIS:The New York City Experience
Michael Andreas Hansen, MPH,
Melissa Mickle-Hope, MPH, Vikki Papadouka, PhD, MPH,
Amy Metroka, MSW, and Jane R. Zucker, MD, MSc
New York City
Department of Health and Mental Hygiene
Bureau of Immunization
42th National Immunization Conference
Atlanta, GA
March 19, 2008
New York City Background
•Population: 8.2 million
•Annual birth cohort of ~125,000
•High mobility of the population within the city
•Child immunizing sites ~1,800
•Child immunizing practitioners ~ 5,000
•72.0% coverage rate for 4:3:1:3:3:1 (NIS 2006)
Citywide Immunization Registry(CIR)
•Mandatory reporting of immunizationsadministered to children
–Birth to <–Birth to < 8 years old since January 1, 1997
–Birth to < 19 years old since August 18, 2005
•3.3 million records and over 33 millionimmunization events
•Birth certificates loaded weekly
NYC Vaccines for ChildrenProgram (VFC)
•75% of children receive vaccines from VFC
–Includes S-CHIP
•Non-universal project
•3.3 million vaccine doses distributed in 2007 toprivate practices, hospitals and clinics
Accounting for VFC Vaccines: ProviderGenerated Doses Administered Report (DAR)
•Required to order VFC vaccine
•Paper form which requiresfaxing
•Self reported by provider ofaggregate doses
•Problems:
–Time consuming for provider tocomplete
–Time consuming for VFC staff tomanually enter into VFC database
–Data non-verifiable: aggregate reportsdo not permit program audit
–Duplicative process: providers reportsimilar information to DOHMH via CIR
CIR-Generated DAR
•Report that compares number of dosesreported to the CIR to the number ofdoses distributed by the VFC programduring the same period
Implementation ofCIR-Generated DAR
•Providers notified in January 2006 ofpolicy change effective September 1, 2006
–Provider generated DAR no longer accepted
–Required to report to CIR > 90% of dosesshipped to receive full order
•Providers received quarterly CIR-generated DARs beginning in June 2006
Implementation of Policy Change ofOrdering Vaccines from VFC
•Reduced order algorithm establishedbased on CIR reporting
– Above 80%: 100% approved
– 60% to 80%: 90% approved
– 30% to 60%: 75% approved
– Below 30%: 50% approved
Distribution of Provider DARs
Aggregate NYC DAR
Date
Number ofProviders
PE1 DosesReported toCIR
DosesDistributedby VFC2
AggregateDAR
June 2006
1180
1,150,837
1,557,107
74%
August 2006
1296
1,292,200
1,577,102
82%
February 2007
1615
2,060,227
2,317,472
89%
August 2007
1662
2,173,700
2,384,280
91%
February 2008
1757
2,525,919
2,648,760
95%
1 PE – Potentially Eligible: – include doses with no VFC eligibility reported
2 Does not include Flu vaccines and vaccines distributed by VFC NYC forspecial NYC funded projects for persons over 18 years old
Increased CIR Reporting
Immunizations Added in CIRSince 2005 – All Ages
Capturing VFC Eligibility
UTD Coverage Assessment
•Improved vaccine accountabilitymethods resulted in improved reporting
•Enhanced ability to measure and trackUTD coverage via IIS
–IIS level
–Provider level
Provider Feedback
CIR-generated UTD (4:3:1:3:3:1)for 2 year old Children
•Includes children with an immunization after one year of age
Report date
# UTD
N
% UTD
05/31/06
30,006
89,351
34%
08/31/06
32,965
92,228
36%
11/30/06
35,318
95,192
37%
01/31/07
37,261
97,480
38%
05/31/07
39,760
97,813
41%
08/31/07
42,611
100,250
43%
11/30/07
46,062
101,881
45%
02/29/08
46,962
99,236
47%
(3 DTP, 2 Hib, 2 HepB, 2 Polio, 3 PCV)
Sampledate
# UTD
N
Rate
01/07
109
328
33%
04/07
102
314
33%
10/07
122
330
38%
01/08
177
332
53%
CIR-generated UTD*for 10-12 month old Children
* Based on a random sample of 400 children, excluding childrenwith no immunization or only HepB birth dose
Summary and Conclusions
•Improved vaccine accountability method
–Reduced paperwork for provider and VFC staff
•Sustained improved reporting to CIR
–70% increase between 2005 to 2006
–Sustained in 2007
•Increased ability to measure UTD coveragevia IIS allows us to give valuable feedback toproviders
•Increased coverage rates
Future Developments
•Expand provider report card to includeadolescent coverage
•Enhance web application so that providerscan generate UTD coverage rates and listsof children that are not UTD on their own
•Add VFC functions to IIS
–Vaccine Ordering
•Will facilitate providers’ ability to report vaccine lots
–Vaccine Inventory
–VFC Enrollment