Daniel Hopfensperger Program Manager Wisconsin Immunization Program Using Immunization Information Systems and Performance Based Contracts to Improve Childhood Immunization Rates Daniel Hopfensperger Program Manager Wisconsin Immunization Program

Outline Performance Based Contracts National Immunization Survey Core Functions of Public Health Population based assessments Wisconsin Immunization Registry Continuous Quality Improvement

Performance Based Contracts Serves as basis for providing funds to local health departments (LHDs) Process began in CY2000 Objectives must be observable and measurable Process objectives not allowed Cost and outcomes for each objective negotiated Original focus was for LHDs to reach 90% goal for children they serve based on a CASA assessment Originally included recoupment for non-attainment

Immunization Program Boundary Statement The boundary statement sets the parameters of the program within which the LHD, Tribe or agency will need to set its objectives. The boundaries are intentionally as broad as federal and state law permit to provide maximum flexibility. However, if there are objectives or program directions that the program is not willing to consider or specific programmatic parameters, those are included in the boundary statement. LHDs, Tribes and agencies are encouraged to leverage resources across categorical funding to achieve common program goals. The Wisconsin Immunization Program aligns well with the boundaries of the WIC and MCH Programs.

Boundary Statement Long-term goals Target Populations Continuous Quality Improvement (CQI) Target Populations Optimal of Best Practice Guidance Unacceptable Proposals Relationship to State Health Plan: Healthiest Wisconsin 2010

Immunization Program Quality Criteria Generally high program quality criteria for the delivery of quality and cost-effective administration of health care programs have been, and will continue to be, required in each public health program to be operated under the terms of the contract. Contractees indicate the manner in which they will assure each criterion is met for the program.

Quality Criteria Include: Assessment and surveillance Delivery of public health services Record keeping Information, education, and outreach Coordination A referral network Provision of guidance to staff Financial management practices Data collection, analysis and reportiing

National Immunization Coverage Benchmark 4:3:1:3:3:1 Wisconsin 2005 NIS data: 77.1% National 2005 NIS: 76.1% Wisconsin 2006 NIS data: 80.5% National 2006 NIS data: 77.0% Be sure to point out/acknowledge that the NIS data is differernt than WIR data.

Wisconsin Immunization Program NIS Data 2005-2006 By individual Sentinel Antigens

Wisconsin Immunization Program NIS Data 2005-2006 By Individual Antigen

NIS Survey Results Although Wisconsin did not lose ground, we did not grow as other states did. Our goal is to increase immunization rates so that we can assure that we will achieve the 2010 goals of 90% coverage for 4:3:1:3:3:1

Core Functions of Public Health Assessment Policy Development Assurance

Population based objectives By December 31, 2008 __% of infants born to families residing in __ Health Department jurisdiction who turn 24 months of age during the contract year will have received 4 DTaP, 3 Polio, 1 MMR, 3 Hib 3 Hepatitis B and 1 varicella vaccination. Agencies must attain or be making progress towards the goal of 90% Accomplishment will be based on % increase according to the table in the context section

Context Guidelines for determining increase needed for progress towards 2010 goals If current baseline is: Increase required: <50% 10% 50 - 59% 5% 60 - 69% 4% 70 - 79% 3% 80 - 85% 2% 86 - 89% 1% >90% maintain

Wisconsin Immunization Registry (WIR) Statistics as of March 08 5.9 Million Client Records 38 Million Immunizations 15,000 Immunizations entered per day 1,200 Providers at 3,500 sites 76 Hospitals with access (60 entering data) 14,000 active users 1,000 active users between 7:30 - 4:30 2,747 Schools using the registry 9,000 Public Access per Month

WIR Benchmark Report Birth date between 01/01/2005 – 12/31/2005 Date report generated Generated by Name of health department Clients residing in county Both clients that DID or did NOT meet selected benchmark(s) Just consider immunizations meeting benchmark Birth date between 01/01/2005 – 12/31/2005 Evaluation date: 01/01/2008 Benchmark age @ 24 months Selected benchmarks: DTaP (4), Hep B (3), Hib (3), MMR (1), Polio (3), Varicella (1) Total clients: 602 clients (81%) met all benchmark criteria, 143 clients (19%) did not

Wisconsin Immunization Program Number of Counties in Each Coverage Rate Range By Year 4:3:1:3:3:1 series by 24 Months of Age 2002 – 2006 Data Source: Wisconsin Immunization Registry (WIR) Benchmark Report Update with 2007 data

Value expressed as percentage 24 month Immunization Rates- 4 DTaP, 3 Polio 1 MMR, 3 Hib, 3 Hep B, 1 Varicella WIR Data Birthdate Range 01/01/2005 to 06/30/2005 Evaluation Date 07/01/2007 Data Source: WIR Key Value expressed as percentage Under 50 50 to 59 60 to 69 70 to 79 80 to 89 90 and above This graph WI’s regional Immunization Data based on WIR reports “Wanna be Green”

Key Challenges Identification and inclusion of all partners, concerns, barriers and perceived relevancy Challenges with border counties/states Challenges with Pocket of Need GIS to county level only Interface with all immunization registries i.e., RECIN, Internal systems

Key Challenges How to raise awareness and consistant use Immunization Registries, i.e. WIR, EMR/billing The completeness of immunization registry data directly impacts registry usefulness. Need to address: Lack of provider participation in registries (staffing, willingness, technical skill set, cost, interface with EMR, etc.) Assess accuracy of data entry

CQI Immunization Goals Overview What are the Immunization CQI goals? Assess where we are now (public and private) Identify strategies to improve immunization rates per county or jurisdiction Include all partners in identifying and addressing all priority concerns

Key Questions to Identify areas of Priority Concerns! How do you determine who is uninsured or underinsured in your community? Which area providers are not yet WIR users or are not using WIR effectively? What is the immunization coverage rate of the people in your community, to include special populations, i.e. WIC, adults, adolescents, elderly, immigrants/migrants?

Key Questions to Identify areas of Priority Concerns! How do you determine what the immunization coverage rate is of your special populations? What are the health priorities of the community as identified by the Community Health Improvement Process Survey (CHIPS)?

Our CQI process will build on our strengths-- Wisconsin Immunization Registry (WIR) Electronic immunization data collection and storage system Secure, confidential, convenient (Web based) Free WIR is the best tool we have in our assessment arsenal for coverage at the local level

For more information please contact: Daniel Hopfensperger Program Manager Wisconsin Immunization Program Phone: 608-266-1339 E-mail: hopfedj@dhfs.state.wi.us