Improving Reporting and IIS-Based Coverage by Conducting VFC Accountability Through 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, % coverage rate for 4:3:1:3:3:1 (NIS 2006)

Citywide Immunization Registry (CIR) Mandatory reporting of immunizations administered to children –Birth to < –Birth to < 8 years old since January 1, 1997 –Birth to < 19 years old since August 18, million records and over 33 million immunization events Birth certificates loaded weekly

NYC Vaccines for Children Program (VFC) 75% of children receive vaccines from VFC –Includes S-CHIP Non-universal project 3.3 million vaccine doses distributed in 2007 to private practices, hospitals and clinics

Accounting for VFC Vaccines: Provider Generated Doses Administered Report (DAR) Required to order VFC vaccine Paper form which requires faxing Self reported by provider of aggregate doses Problems: –Time consuming for provider to complete –Time consuming for VFC staff to manually enter into VFC database –Data non-verifiable: aggregate reports do not permit program audit –Duplicative process: providers report similar information to DOHMH via CIR

CIR-Generated DAR Report that compares number of doses reported to the CIR to the number of doses distributed by the VFC program during the same period

Implementation of CIR-Generated DAR Providers notified in January 2006 of policy change effective September 1, 2006 –Provider generated DAR no longer accepted –Required to report to CIR > 90% of doses shipped to receive full order Providers received quarterly CIR- generated DARs beginning in June 2006

Implementation of Policy Change of Ordering Vaccines from VFC Reduced order algorithm established based 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 DateNumber of Providers PE 1 Doses Reported to CIR Doses Distributed by VFC 2 Aggregate DAR June ,150,8371,557,10774% August ,292,2001,577,10282% February ,060,2272,317,47289% August ,173,7002,384,28091% February ,525,9192,648,76095% 1 PE – Potentially Eligible: – include doses with no VFC eligibility reported 2 Does not include Flu vaccines and vaccines distributed by VFC NYC for special NYC funded projects for persons over 18 years old

Increased CIR Reporting

Immunizations Added in CIR Since 2005 – All Ages

Capturing VFC Eligibility

UTD Coverage Assessment Improved vaccine accountability methods resulted in improved reporting Enhanced ability to measure and track UTD 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# UTDN% UTD 05/31/0630,00689,35134% 08/31/0632,96592,22836% 11/30/0635,31895,19237% 01/31/0737,26197,48038% 05/31/0739,76097,81341% 08/31/0742,611100,25043% 11/30/0746,062101,88145% 02/29/0846,96299,23647%

(3 DTP, 2 Hib, 2 HepB, 2 Polio, 3 PCV) Sample date # UTDNRate 01/ % 04/ % 10/ % 01/ % CIR-generated UTD* for month old Children * Based on a random sample of 400 children, excluding children with 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 coverage via IIS allows us to give valuable feedback to providers Increased coverage rates

Future Developments Expand provider report card to include adolescent coverage Enhance web application so that providers can generate UTD coverage rates and lists of 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