“THIS WILL TAKE JUST A MINUTE OF YOUR TIME” USE OF REGISTRY TO VERIFY RANDOM DIGIT DIAL SURVEY INFANT COVERAGE DATA San Diego Immunization Program

SDIP The San Diego Immunization Program Established in 1992 County of San Diego HHSA the lead agency Collaborative of community agencies and programs Access and availability of immunization services Community education and outreach Assessment and evaluation

SDIR The San Diego Regional Immunization Registry Established in 1997 Enhancements to web application Data exchange with Imperial County PROW assessment site Health Plan interactions Latest stats: over half million clients with IZ records

What is the RDD Telephone Survey? Survey of immunizations of San Diego County residents Ages 19 months and above Provides additional information, wider age range, and larger sample size than National Immunization Survey data on San Diego

Methods of the RDD Telephone Survey Random selected telephone numbers Multi-language interviewers Immunization dates from recall and records Verification of information from providers Weighted statistical coverage

BACKGROUND RDD surveys assess vaccination coverage 1995 – 1998 children’s vaccination dates reported by parents were verified only by directly contacting healthcare providers

VERIFICATION METHODS BEFORE REGISTRY ·  Surveyors called households, requested vaccination dates of children 19–36 months, and permission to verify dates with providers the parents listed. ·  For children not UTD according to parent-reported vaccinations, staff members requested providers to report vaccination dates. ·  Staff entered shot dates from parents & providers into database

VERIFICATION METHODS WITH REGISTRY AND PROVIDERS Since 1999, the first year the Registry was available, children not UTD were looked up in the Registry to verify vaccination If UTD in Registry, then the provider was not contacted Children not UTD in the Registry were further verified by contacting their providers

VERIFICATION RESULTS WITH REGISTRY OR PROVIDER Denominator = number of children whose records we should verify (parents gave permission to verify & not UTD in parents’ records). If child is UTD in Registry, we do not try to verify further. Not verified (red) because: we could not find provider, provider not find child in records, a few providers declined to verify. 1995: we did not calculate verification results, because in that first year, they collected little data on verification process. 1999: we did not calculate, because in the first year of the Registry, they used the Registry little for verification. 2001: no RDD survey. 2003: UTD in Registry (yellow) lower than in 2002, because 2003 UTD included Hep A & pneumococcal. Before Registry With Registry

VERIFICATION RESULTS WITH REGISTRY Denominator = number of children whose records we should verify (parents gave permission to verify & not UTD in parents’ records) Any IZ in Registry = had any shot dates in Registry, whether UTD or NUTD UTD in Registry lower in 2003 than 2002, because 2003 UTD included Hep A & pneumococcal

CHALLENGES OF USING REGISTRY Misspelled names Different names on different records Wrong birth dates Overcome by searching alternatives until find matching information These problems are easier to solve with Registry than with providers

BENEFITS TO IMMUNIZATION STAFF Verifying in the Registry is faster than by contacting provider Easier to try alternate spellings and birth dates in the Registry Finding discrepancies in data enables correcting Registry data Registry always works, but some faxes to & from providers are lost in transmission Able to verify more children with Registry + providers than with only providers

BENEFITS TO CLINICIANS Need to verify fewer children’s vaccinations for the Immunization Program’s surveys The average provider’s list of children decreased from 7 to 6 children; greater reductions for providers using Registry Clinics who use only the Registry for vaccination record keeping need not verify any shot dates Reduced requests for data from public health maintains relationships

CONCLUSIONS As more providers increase the numbers of children in the Registry, it becomes more useful for verifying vaccination coverage In future, Registry alone might be used to calculate vaccination coverage instead of conducting surveys