Moved and Gone Somewhere: Cross-Jurisdiction Implications of MOGEs CHEAR Unit, Division of General Pediatrics, University of Michigan Moved and Gone Somewhere: Cross-Jurisdiction Implications of MOGEs Kevin Dombkowski, DrPH, MS April 19, 2010

If MOGEs have moved or gone elsewhere……… …..where did they go?

Learning Objectives Understand where MOGEs go after they’ve moved Explore the implications of cross-jurisdiction MOGE migrations Consider potential strategies to minimize MOGE impacts

MOGE Status MOGE status affects: MOGEs can be a major issue for LHDs reminder / recall notifications vaccination coverage assessments MOGEs can be a major issue for LHDs Little is known about migration of MOGEs between public health jurisdictions

Objectives Assess the degree of movement between public health jurisdictions among children with MOGE status Describe characteristics of MOGEs and their migration patterns

Study Design Collaboration with: Immunization officials from the Michigan Department of Community Health (MDCH) Michigan Care Improvement Registry (MCIR)

Study Design Children ≤19 yrs. with MOGE status in the Michigan Care Improvement Registry (MCIR) Focused on 12 local health jurisdictions comprising 15 counties in southwest Michigan MOGEs identified August 2009

Study Design Address information was standardized and matched using the U.S. Postal Service NCOALink database Looked for changes within 48 months Two stages: Parent name Child name

Study Design Summarized change of address by county, LHD jurisdiction, and state demographics of children with changes

Using the NCOA Database

Standardization Success 66,338 MOGEs identified ~9% of children ≤19 yrs. in study area 19,600 (30%) could be standardized 3,018 (15%) of standardized cases could be matched to a forwarding address Matched cases varied across child characteristics

Where do the MOGEs Go?

MOGE Destination Analysis Among MOGEs with a matched forwarding address: 52% had a forwarding address in the same county 16% moved to another county in Michigan: 10% - adjacent county 6% - non-adjacent county 33% moved to another state

Where do the MOGEs Go?

67% remained in the state

12% of moves were clustered in 4 states

Another 11% were clustered in 8 states

11% moved to the remaining states

LHD Jurisdiction Level

Moved to the same county

Moved to the same county

Moved to the same county

Moved to another county

Moved to another county

Moved to another state

Moved to another state

Moved to another state

Limitations Changes of address reflect children with prior address in Michigan Does not characterize in-migration patterns from other regions of Michigan or other states

Conclusions Many children with MOGE designation have moved to new addresses outside the public health jurisdiction of their last known address These findings underscore the importance of maintaining current contact information in a statewide IIS Resource considerations: Cost of undeliverables Cost of locating MOGEs

Implications Vaccination coverage assessments that include MOGEs: likely understate the coverage of the actual resident population include children that cannot be reached by mailed recall notifications

Implications Additional strategies are needed to reconcile the impact of cross-jurisdiction MOGE migrations on: local health department vaccination coverage assessments recall notifications One possible strategy could entail the use of NCOA process on a ongoing basis

Example Strategy Find historical information for those with missing addresses: Medicaid WIC Drivers license Head Start Health plans Submit for NCOA matching periodically Prior to assessments and reminder recall cycles

Acknowledgements Many thanks to my collaborators at: University of Michigan Michigan Dept. of Community Health Michigan Care Improvement Registry Local Health Departments Centers for Disease Control and Prevention

Thank you for your attention! kjd@med.umich.edu Let’s start with a thumbnail sketch of the history of public health in Michigan… The Board of Health was initially established, largely in response to such public health threats as exploding oil lamps and arsenic in wallpaper. An important milestone that has major implications for local public health in Michigan is the Public Health Code, adopted in 1978 Lastly, an important point in more recent history affects the basic organization of state-level public health activities, forming the Michigan Dept. of Community Health through the consolidation of the Medical Services Administration, the administrative unit responsible for Medicaid in Michigan, and the Department of Public Health. This puts Michigan in a unique – and advantageous position of being one of about 12 states with a unified public health / Medicaid organization.