1. Provider Participation in State Immunization Registries Sarah Clark Anne Cowan University of Michigan Child Health Evaluation and Research Unit Division of General Pediatrics, University of Michigan

2. Background Immunization registries… Offer many tangible benefits Require considerable investment Depend on broad participation from vaccine providers within the target area to ensure accurate and useful information

3. Background Critical Questions: 1.Do private-sector vaccine providers participate in immunization registries? 2.What does “participate” mean?

4. Background Research requested by: Michigan Department of Community Health Michigan Childhood Immunization Registry (MCIR) CDC’s National Immunization Program Assessment of registry participation nationwide

5. Background Challenges to national assessment: Registries vary in size, scope, stage of registry development, and roll-out of private provider recruitment

6. Background Challenges to national assessment: Registries vary in size, scope, stage of registry development, and roll-out of private provider recruitment Typically, there is no “denominator”

7. Background Challenges to national assessment: Registries vary in size, scope, stage of registry development, and roll-out of private provider recruitment Typically, there is no “denominator” Often providers are not directly involved in vaccine administration and recording, and are unaware of registry participation

8. Background Response: Focus the research on registry participation among private-sector VFC participants. Limit the research to statewide registries only.

9. Study Objectives To estimate provider participation levels in Michigan, and in a sample of 16 state registry programs. To enhance understanding of influences on provider participation in immunization registries.

10. Methods Design Mailed survey of participating VFC providers in: Survey #1: Michigan Survey #2: a sample of 16 states with variation in the estimated proportion of private providers who participate in the statewide registry Separate surveys for registry participants and non- participants

11. Methods Selection of Participants Match of VFC and registry participant lists If site on both lists: Participant If site on VFC only: Non-Participants “VFC Contact” used as survey respondent for site; if not at site, then “registry contact” became survey respondent

12. Methods Survey items Verification of registry participation status Practice demographic characteristics Influences on participation / non-participation Uses of registry (participants only) Importance, likelihood of future participation (non-participants only)

13. Results: MCIR Survey Participants 282 respondents, out of 396 (71% response rate) – 272 eligible for survey completion – 10 ineligible Non-Participants 48 respondents, out of 82 (59% response rate) –44 eligible for survey completion –4 ineligible

14. Results: MCIR Survey Of 272 eligible “Participant” respondents: –244 reported self/practice as participants –24 reported self/practice as non-participants –4 were unsure

15. Results: MCIR Survey Of 272 eligible “Participant” respondents: –244 reported self/practice as participants –24 reported self/practice as non-participants –4 were unsure Of 44 eligible “Non-Participant” respondents: –30 reported self/practice as participants –14 reported self/practice as non-participants

16. Results: MCIR Survey Of 272 eligible “Participant” respondents: –244 reported self/practice as participants –24 reported self/practice as non-participants –4 were unsure Of 44 eligible “Non-Participant” respondents: –30 reported self/practice as participants –14 reported self/practice as non-participants Overall match is 87%.

17. Results: MCIR Participants # of Vaccines Administered per Week <10 vaccines17% 10-25 vaccines26% 26-100 vaccines38% >100 vaccines19% % of Patients with Medicaid <10%27% 10% - 50%56% >50%17%

18. Results: MCIR Participants How participants use MCIR in practice 88% input data on vaccines given 81% review records of individual patients 62% print immunization records for patients 30% assess practice immunization coverage 20% generate reminder/recall notices

19. Results: MCIR Participants Total number of uses: 64% reported 3 or more uses of MCIR 4% do not use MCIR in any way

20. Results: MCIR Participants Factors “very influential” to participation 56% state mandate 55% need to consolidate records for patients who receive vaccines from multiple sites

21. Results: MCIR Participants Factors “very influential” to participation 56% state mandate 55% need to consolidate records for patients who receive vaccines from multiple sites 45% ability to use MCIR to monitor practice rates 46% health plan mandate

22. Results: MCIR Participants Factors “very influential” to participation 56% state mandate 55% need to consolidate records for patients who receive vaccines from multiple sites 45% ability to use MCIR to monitor practice rates 46% health plan mandate 38% staff in favor of participation 37% compatible technology

23. Results: MCIR Participants Who inputs MCIR data? –74% nurses, 32% clerical, 6% other

24. Results: MCIR Participants Who inputs MCIR data? –74% nurses, 32% clerical, 6% other How long does it take per week? –43% less than 2 hrs/wk –35% 2-5 hrs/wk –10% more than 5 hrs/wk –11% unsure

25. Results: MCIR Participants Who inputs MCIR data? –74% nurses, 32% clerical, 6% other How long does it take per week? –43% less than 2 hrs/wk, –35% 2-5 hrs/wk –10% more than 5 hrs/wk –11% unsure What mode of interaction is used? –36% internet, 34% modem, 30% paper copy

26. Results: MCIR Participants Experience with MCIR Problems SmallSignificant Cost/staff time47%14% Computer compatibility29%11% Access difficulty32%11% Accuracy of data44%17% Confidentiality16%5%

27. Results: MCIR Non-Participants Reasons for non-participation: 45% too much staff time/cost 45% only a few pediatric patients 45% insufficient technical assistance 18% not compatible with office computer 9% practice has own system 0% confidentiality concerns

28. Results: MCIR Non-Participants Factors “essential” to participation 64% On-site technical assistance 55% Automated data entry 55% Technological compatibility

29. Results: Non-Participants Factors “essential” to participation 64% On-site technical assistance 55% Automated data entry 55% Technological compatibility 45% Practice staff support participation 36% State mandate 36% Legal advice re: confidentiality concerns

30. Results: Non-Participants Factors “essential” to participation 64% On-site technical assistance 55% Automated data entry 55% Technological compatibility 45% Practice staff support participation 36% State mandate 36% Legal advice re: confidentiality concerns 27% Increased participation in my community 18% Recommendation from medical society

31. Results: MCIR Non-Participants Likelihood of MCIR participation within 2 years (1 – 10 scale) 1-3……....…....5-6………….8-10 30% 30% 40%

32. Conclusions: MCIR Survey 1)Very good participation rates 2)Good consistency between state records and provider perception of participation 3)Common influences/barriers 4)Limitation of survey that little information was gathered on misclassified providers

34. National Survey: Barriers 1)NIP information on the proportion of provider participation in various statewide registries is often ambiguous or inconsistent with state information

35. National Survey: Barriers 1)NIP information on the proportion of provider participation in various statewide registries is often ambiguous or inconsistent with state information 2)States had concerns about surveying providers in when registry is not fully functional

36. National Survey: Barriers 1)NIP information on the proportion of provider participation in various statewide registries is often ambiguous or inconsistent with state information 2)States had concerns about surveying providers in when registry is not fully functional 3)Some states had concerns about sharing VFC, registry participant lists

37. National Survey: Barriers 1)NIP information on the proportion of provider participation in various statewide registries is often ambiguous or inconsistent with state information 2)States had concerns about surveying providers in when registry is not fully functional 3)Some states had concerns about sharing VFC, registry participant lists 4)Staff at state programs had other priorities.

38. National Survey: Barriers The Big Question: Is a “national assessment of private provider participation in immunization registries” a reasonable goal?

39. National Survey: Progress 1)Survey fielded in 6 states 2)Good response rate in 5 of 6 3)Different problems/concerns in others

40. Conclusions: Overall State surveys provide useful information.

41. Conclusions: Overall State surveys provide useful information. State and national policymakers need information on the results of the registry effort.

42. Conclusions: Overall State surveys provide useful information. State and national policymakers need information on the results of the registry effort. Problems inherent in national surveys may be too difficult to overcome.

43. Conclusions: Overall State surveys provide useful information. State and national policymakers need information on the results of the registry effort. Problems inherent in national surveys may be too difficult to overcome. Continue to seek solutions and gather information, to allow continued assessment of registry progress.