Immunization Assessments: More Than a Single Visit NYC Department of Health Immunization Program

Assessments: More Than A Single Visit Karin Seastone Stern, DrPH,Director Clinic Assessments Denise Benkel, MD, MPH, Medical Specialist, Child Health Initiative Stephen Friedman, MD MPH, Assistant Commissioner Paula Francis-Crick, IAP Assessment Team Member Frank Roldan, CDC, Program Operations Director For more information contact kstern@health.nyc.gov

NYC 5 Boroughs 722 miles of subway 108,000 2-Year Olds 1,200 VFC Private Providers 70 Public Hospitals & Child Health Clinics 2001 Assessments: Represented 12,000 11% of 2 Yr Old Population 4,000 Chart Reviews

Assessment Feedback Report Feedback Meeting Process Chart Review – Paper Tool and Computer Entry Coverage @ 2nd birthday and @ date of assessment 4:3:1:3:3 and varicella Feedback Report Identify Barriers including MOV, Chart Organization Recommendations List Under-Immunized Children Feedback Meeting

Utilize the assessment Follow-up Actions Utilize the assessment Listed under-immunized children DOH promised to return in 2-3 months to reassess charts Actively involve the provider Provider needs to re-review incomplete charts Provider recalls / deactivates charts / utilizes the registry Provider initiates changes in the practice Incentive Re-calculate coverage rates for the cohort Incorporate changes into the practice

List of Under-Immunized Children to Recall

Outcome: Increased coverage after recall 11 weeks after assessment 18-35 month olds (N=19 providers)

4:3:1:3:3 Series coverage at assessment and after recall 18 – 35 months of age, 19 sites, 2001

Reasons associated with missed opportunity to vaccinate 43 Public Clinics and Private Providers, 2001 (n=748)

Barrier: Accepting and Giving Excuses Intervention Turn the excuse into an explanation

“But, the complications are NOT mild.” “Chickenpox is a mild disease.” “But, the complications are NOT mild.” Protect the other family members. If parent refuses, document chart.

Approaches to overcoming provider as barrier Here’s a copy of our paper tool, please correct it if we are wrong. Here’s a copy of the immunization schedule, let’s review what is not clear. Pretend we’re your consultant.

Passive process Active process Adversary Advocate ASSESSMENT: More than a single visit Passive process Active process Adversary Advocate For this cohort, significant improvement in coverage Initiate clinical & administrative changes Establish precedent for continued improvement

Assessment Team Members IAP Cheryl Bodden Paula Francis Crick Timothy Salters VFC Cassandra Deas Daryl Perry Polly Hobbs Vasu Nalipireddy