Keys to Practice-Based Immunization Recall Sarah J. Clark, MPH Ericka Hudson, MHSA Kevin J. Dombkowski, DrPH Child Health Evaluation and Research Unit (CHEAR) University of Michigan National Immunization Conference April 1, 2009

Background Immunization reminder/recall shown to be effective in increasing childhood immunization rates. Identify kids who are eligible or overdue to vaccine dose(s) Notify providers and/or parents about the need for vaccination

Background BUT immunization reminder/recall is not necessarily easy. It requires: Reliable system of identifying children’s immunization status Personnel who know how to manipulate the system Accurate contact information for notification targets

Purpose To describe the extent to which practices are able to conduct immunization reminder/recall

Methods Study setting: Detroit metropolitan area Targeted sampling to recruit a variety of practices that provide childhood immunizations Invited to participate in an intervention to increase the use of immunization recall using the Michigan Care Improvement Registry (MCIR)

Study Design Participating practices were: asked to conduct immunization recalls for 19-35 month old children provided with hands-on MCIR training and ongoing technical support asked to conduct 4 recalls over a one year period

Participation Onsite training from MCIR Regional staff : General MCIR recall training + manual Hands-on assistance with initial set-up (e.g., building roster, running test recall) Ongoing support Training ranged from 30 minutes to several days “Best-case scenario” for practice-based recall

Practice Characteristics 17 practices 15 private offices; 2 CHCs 13 pediatric practices; 4 family/general med All used MCIR at study entry; all but one interfaced via high-speed internet 10 practices reported some experience with recall, typically through health plans

Recalls March 2007 – May 2008: Practices conducted a total of 56 recalls: ≥1 recall: 94% (16 of 17 practices) ≥2 recalls: 82% (14 practices) ≥3 recalls: 65% (11 practices) ≥4 recalls: 53% (9 practices) 1 practice did not conduct any recalls

Recalls To put it another way: 1 practice did not conduct any recalls 2 practices conducted only 1 recall 3 practices conducted only 2 recalls 2 practices conducted 3 recalls 9 practices conducted ≥4 recalls

WHY such variation? “If you’ve seen one practice,

A practice

A practice

Recall Challenges Perceived burden of recall greater than staff availability 1 practice was trained but decided that they did not want to participate further. Similar practices probably declined study participation altogether. This is a significant challenge in getting in the door for practice-based recall!

Recall Challenges Practice disruptions Of the 2 practices that conducted only 1 recall, one closed; the other moved to a different location.

Recall Challenges Issues with data accuracy classic: accurate info in practice record, registry info not updated or incorrect

Recall Challenges Issues with data accuracy classic: accurate info in practice record, registry info not updated or incorrect high-tech: automated transfer of info from practice record to registry problematic (e.g., Pediarix)

Recall Challenges Issues with data accuracy classic: accurate info in practice record, registry info not updated or incorrect high-tech: automated transfer of info from practice record to registry problematic (e.g., Pediarix) systemic: practice info not correct

Recall Challenges Exceptions Practice-specific immunization schedule Shortage situations Waivers

Recall Challenges Technical issues minor procedural problems create temporary barriers “learning curve” time requirement is greater for initial recalls

Recall Challenges Disconnect between recall “worker bees” and clinical providers time commitment perceived benefit support for recall vs other tasks

Overcoming Barriers Keys to overcoming barriers Ongoing training Ongoing technical support Ongoing moral support

Future Recalls 10 practices thought they would continue registry-based recalls most high performers a few late bloomers Most prefer recalls to be done at practice level

Future Recalls 3 practices do not plan to continue registry-based recalls staff/time burden too high prefer recalls to be done by health plans or health departments

Future Recalls 4 practices uncertain about future recall use prefer recalls to be done by health plans, with practice to supplement

Summary In this “best-case scenario” situation, about half of practices could achieve goals for recall frequency Recall challenges should be expected, and may require substantial time to overcome

Summary Some practices may not be capable of sustaining practice-based recall Different levels of reminder/recall should be considered: practice level LHD/county health plan

Acknowledgements MCIR regional and state staff MDCH Immunization Division Practice staff