Presented by Anne Cordon, SDIR Manager Don’t Be A Bad Shot! Registry Data Quality Review & Immunization Practice Presented by Anne Cordon, SDIR Manager Session K3 March 9, 2006

Acknowledgements Kathleen W. Gustafson, MPH & Sue Hunt, PHN: Immunization Branch, County of San Diego, Health & Human Services Agency Wendy Wang, MPH, Robert Grieger, Tracy Healy, Med, Mark H. Sawyer,M.D., Michelle DeGuire, MPH, MSW: San Diego Immunization Partnership, University of California San Diego (UCSD)

SDIR Background Approx. 10 years old Standalone  Client Server  Web-based application (June 2004) Web version has more data entry checks than previous versions Records have been added consistently Review of record complete

SDIR at a glance 302 sites and approx. 600 active users All public health centers and community clinics Private providers 9 school districts Potential universe of SDIR sites and users: 20 hospitals +250 private providers 5,000 child care providers 40 more school districts 100 state licensed skilled nursing facilities

Quality measures for immunizations Hep A given before 1995 Hib given above age 5 Influenza dose before 6 months of age More than 3 does of MMR PCV7 given after age 5 PPV23 doses for children under 2 years of age Td < Age 7 Varicella dose given before 12 months of age and/or 1995

Some Data Review Details MMR More than 3 doses of MMR, which is defined as is a dose before one year of age and two valid doses after a year of age More than 3 doses before Age 2. PPV 23 Given before Age of 1 Given before Age 2 as of 2/6/06 Varicella Given before 1995. Given < age 13 Months. Given < 12 mths and before 1995

Test conditions Important to define and review report criteria/exceptions. Example: Test cond.: Demographic and shot date_mod <= ’31-Dec-2005’ as applicable. Results: Minimum and Maximun vacc_date Results: Counts: ipid, Shot and avg shots/ipid Results: Min and Max Age shot

Hepatitis A results Data Checks 1B=1C + 1D (active only)

Data Checks Vaccine Min/Max= range of shot dates Min/Max Age=range of ages Ipid=distinct patient demographic records Shots/ipid= can be more than 1 since there can be more than one recording of a vaccine and date

Hib results

Influenza

Next steps: Internally review the data summaries Run queries to get client data Organize data by provider Follow protocol for giving data to provider for chart review and data clean-up Follow-up with provider Check data for correction

Issues to consider Age of shot data Age of patient How to address paperless systems Ability to retrieve archived records Importance of correcting old data vs. addressing current data entry or vaccine practices

SDIR role Inform provider of data issues Be a resource in data clean-up Doesn’t correct data without a record or chart copy with correct data Use Help Desk staff to work on clean-up Report back to provider on cleaned data

Future data quality assurance Start regular and periodic reviews from last data review on forward Design application enhancements to decrease or eliminate future data entry errors Enhance training to alert users to use registry ‘real-time’

For more information Anne M. Cordon, MPH, CHES SDIR, Immunization Branch County of San Diego HHSA P.O. Box 85222, MS P-511B San Diego, CA 92186-5222 anne.cordon@sdcounty.ca.gov (619) 692-8403