1. Moved and Gone Somewhere: Cross-Jurisdiction Implications of MOGEs
CHEAR Unit, Division of General Pediatrics, University of Michigan
Moved and Gone Somewhere: Cross-Jurisdiction Implications of MOGEs
Kevin Dombkowski, DrPH, MS
April 19, 2010

2. If MOGEs have moved or gone elsewhere………
…..where did they go?

5. Learning Objectives Understand where MOGEs go after they’ve moved
Explore the implications of cross-jurisdiction MOGE migrations
Consider potential strategies to minimize MOGE impacts

6. MOGE Status MOGE status affects: MOGEs can be a major issue for LHDs
reminder / recall notifications
vaccination coverage assessments
MOGEs can be a major issue for LHDs
Little is known about migration of MOGEs between public health jurisdictions

7. Objectives
Assess the degree of movement between public health jurisdictions among children with MOGE status
Describe characteristics of MOGEs and their migration patterns

8. Study Design Collaboration with:
Immunization officials from the Michigan Department of Community Health (MDCH)
Michigan Care Improvement Registry (MCIR)

9. Study Design
Children ≤19 yrs. with MOGE status in the Michigan Care Improvement Registry (MCIR)
Focused on 12 local health jurisdictions comprising 15 counties in southwest Michigan
MOGEs identified August 2009

11. Study Design
Address information was standardized and matched using the U.S. Postal Service NCOALink database
Looked for changes within 48 months
Two stages:
Parent name
Child name

12. Study Design Summarized
change of address by county, LHD jurisdiction, and state
demographics of children with changes

13. Using the NCOA Database

14. Standardization Success
66,338 MOGEs identified
~9% of children ≤19 yrs. in study area
19,600 (30%) could be standardized
3,018 (15%) of standardized cases could be matched to a forwarding address
Matched cases varied across child characteristics

17. Where do the MOGEs Go?

18. MOGE Destination Analysis
Among MOGEs with a matched forwarding address:
52% had a forwarding address in the same county
16% moved to another county in Michigan:
10% - adjacent county
6% - non-adjacent county
33% moved to another state

19. Where do the MOGEs Go?

20. 67% remained in the state

21. 12% of moves were clustered in 4 states

22. Another 11% were clustered in 8 states

23. 11% moved to the remaining states

24. LHD Jurisdiction Level

25. Moved to the same county

26. Moved to the same county

27. Moved to the same county

28. Moved to another county

29. Moved to another county

30. Moved to another state

31. Moved to another state

32. Moved to another state

33. Limitations
Changes of address reflect children with prior address in Michigan
Does not characterize in-migration patterns from other regions of Michigan or other states

34. Conclusions
Many children with MOGE designation have moved to new addresses outside the public health jurisdiction of their last known address
These findings underscore the importance of maintaining current contact information in a statewide IIS
Resource considerations:
Cost of undeliverables
Cost of locating MOGEs

35. Implications Vaccination coverage assessments that include MOGEs:
likely understate the coverage of the actual resident population
include children that cannot be reached by mailed recall notifications

36. Implications
Additional strategies are needed to reconcile the impact of cross-jurisdiction MOGE migrations on:
local health department vaccination coverage assessments
recall notifications
One possible strategy could entail the use of NCOA process on a ongoing basis

37. Example Strategy
Find historical information for those with missing addresses:
Medicaid
WIC
Drivers license
Head Start
Health plans
Submit for NCOA matching periodically
Prior to assessments and reminder recall cycles

39. Acknowledgements Many thanks to my collaborators at:
University of Michigan
Michigan Dept. of Community Health
Michigan Care Improvement Registry
Local Health Departments
Centers for Disease Control and Prevention

40. Thank you for your attention!
Let’s start with a thumbnail sketch of the history of public health in Michigan…
The Board of Health was initially established, largely in response to such public health threats as exploding oil lamps and arsenic in wallpaper.
An important milestone that has major implications for local public health in Michigan is the Public Health Code, adopted in 1978
Lastly, an important point in more recent history affects the basic organization of state-level public health activities, forming the Michigan Dept. of Community Health through the consolidation of the Medical Services Administration, the administrative unit responsible for Medicaid in Michigan, and the Department of Public Health. This puts Michigan in a unique – and advantageous position of being one of about 12 states with a unified public health / Medicaid organization.