Increasing Registry Value Through Partnerships National Immunization Registry Conference Atlanta, Georgia October 28, 2003 Debbie McCune Davis The Arizona Partnership for Immunization

A Statewide Registry… the original vision Improve interaction between providers and families to increase immunizations of children. Establish a single site for storage of childhood immunization information. Complete records available of child’s immunization status. All providers participate, and have access to up to date immunization records.

Partners Arizona Department of Health Services Arizona Health Care Cost Containment System (AHCCCS) County Health Departments Arizona Community Health Centers Commercial Health Plans Private Providers Municipal Fire Departments Department of Economic Security Schools and Day Care Centers

Expand sphere of influence through partnerships ADHS and Counties AHCCCS and Health Plans Arizona Medical Assn. Managed Care Plans Community Health Centers

Medicaid Managed Care 4:3:1 – 78.1% 2001 Mercy Care –80.7% –1,280 Sample size Phoenix Health Plan –83.5% –558 Sample size

Annual Trend in Immunization Rates and Well-child Visits, Children Enrolled in AHCCCS (TXIX) Percent

Community Health Centers Mountain Park Community Health Center –May 2002 –1,276 AHCCCS Kids –94% coverage levels Uses ASIIS for quarterly assessments Identifies high risk patients for recall during flu season children. Coordination with school nurses resulted in 25% fewer referrals of 10 – 14 year olds.

WIC/Immunization Collaboration Shared Vision To Improve Immunization Coverage Rates Develop Strategies that Manage Barriers Maximize Cost Effectiveness Present a Model that works in diverse WIC settings

The Learning Curve

Getting Down to Business

Commercial Managed Care CIGNA Medical Group – Adolescent Initiative

Results/Benchmarks/Goals Adolescents

School Nurses “The first time I used the ASIIS website, I resolved 37 student immunization issues. That meant students whose school registrations were not delayed because of problems with their immunization record. With a daily enrollment of over 750, I can use all the help I can get!” Suzanne Boyd, MS,RN Tucson Unified School District

SE Maricopa County

Phoenix Fire Baby Shots Program “In 2002, we saw 6317 children and provided 13,376 immunizations in our clinics. The majority of children are from Spanish speaking households. All shots were entered into the registry.” Sheri Gibbons, Phoenix Fire Department

County Health Departments “To date we have saved $13, by searching ASIIS for missing immunizations. This total represents a one month tally at three of our locations.” Machrina Smith, RN Maricopa County

Child Protective Services “We average 2-5 requests a day from CPS workers for immunization records. Children have been removed from their homes and must be placed in foster care. Having easy access to immunization records makes it easier to place children with foster parents because there is no barrier to school or day care and no need for a doctor’s appointment to get unneeded shots” Andie Denious, RN

Rural County in Crisis Rodeo-Chedeski Fire – Navajo County – Summer 2002 “Roughly 25,000 residents were displaced as the fire destroyed 250 homes and burned 468,000 acres. Community health workers used the registry to organize tetanus shot clinics. Parents were provided with documentation of past immunizations to ensure re-admittance of children to school.”

Arizona State Immunization Information System Total patients 2,058,909 Total immunizations 16,115,939 Compliance with Healthy People % patients under 6 in registry Enrollment3,251 users/497 sites School/Day Care 1355 users/100+sites

Changing Medical Practice to Change Lives Current medical environment: Rising Costs Population Growth Change in Demographics and utilization patterns Workforce issues Emergency Department – 15% increase Increased medical expectations Registries play a role in meeting every challenge!