1. Improving Accountability of VFC Vaccine Using an Immunization Registry: The New York City Experience
Department of Health and Mental Hygiene
Bureau of Immunization
41th National Immunization Conference
Kansas City, MO
March 7, 2007
Michael Andreas Hansen, MPH,
Vikki Papadouka, PhD, MPH, Amy Metroka, MSW,
Jim Lutz, MPA, and Jane R. Zucker, MD, MSc

2. New York City Background
Population: 8.2 million
Annual birth cohort of ~125,000
High mobility of the population within the city
Child immunizing sites ~1,700
Child immunizing practitioners ~ 5,000
70.5% coverage rate for 4:3:1:3:3:1 (NIS 2005)

3. Citywide Immunization Registry (CIR)
Mandatory reporting of immunizations administered to children
Birth to < 8 years old since January 1, 1997
Birth to < 19 years old since August 18, 2005
2.7 million records and over 24 million immunization events
Birth certificates loaded weekly

4. NYC Vaccines for Children Program (VFC)
75% of children receive vaccines from VFC
Includes S-CHIP
Non-universal project
2.8 million vaccine doses distributed in 2006 to private practices, hospitals and clinics

5. Accounting for VFC Vaccines: Provider Generated Doses Administered Report (DAR)
Required to order VFC vaccine
Paper form which requires faxing
Self reported by provider of aggregate doses
Problems:
Time consuming for provider to complete
Time consuming for VFC staff to manually enter into VFC database
Data non-verifiable: aggregate reports do not permit program audit
Duplicative process: providers report similar information to DOHMH via CIR

6. CIR-Generated DAR
Report that compares number of doses reported to the CIR to the number of doses distributed by the VFC program during the same period

7. Implementation of CIR-Generated DAR
Integration of CIR and VFC databases
CIR facility codes matched to VFC ‘pin’ numbers
CIR generates DARs for all providers
Providers notified in January 2006 of policy change effective September 1, 2006
Provider generated DAR no longer accepted
Required to report to CIR > 90% of doses shipped to receive full order
Providers received quarterly CIR-generated DARs beginning in June 2006

8. CIR Generated Doses Administered Report
Can be easily produced by bureau staff as pdf files and ed or faxed to provider

9. DAR by Hospital Network
A Tool for Network Administrators

10. Implementation of Policy Change of Ordering Vaccines from VFC
Reduced order algorithm established
Above 80%: 100% approved
60% to 80%: 90% approved
30% to 60%: 75% approved
Below 30%: % approved

11. Electronic Record Submission (Includes Paper Submissions)
Implementation of CIR generated DAR
Integration of VFC & CIR databases

12. Increased CIR Reporting

13. Immunizations Added in CIR 2006 – All Ages

14. Capturing VFC Eligibility

15. Distribution of Provider DAR’s

16. Aggregate NYC DAR Feb 07: Jan 06 – Dec 06 1,613 VFC Facilities
# doses distributed: 2,317,342
# doses reported: 2,060,227
% doses reported: 89%
Jun 06: 74%

17. Summary of Providers with Order Reductions
494 providers had reductions of their vaccine order
10% reduction: 258 providers
25% reduction: 152 providers
50% reduction: 84 providers
180 providers had their vaccine order reduced more than once

18. Development of a Provider Profile
Initiated by linking VFC and CIR databases
VFC doses distributed
Doses reported to CIR
Expanded by including:
CIR-generated UTD coverage rates
AFIX-generated UTD coverage rates
Hep B Birth Dose
VFC site visits
Allows coordination between programmatic units across the Bureau

19. Provider Profile Main Menu

20. Provider Profile Database

21. Summary and Conclusions
Improved vaccine accountability method
Reduced paperwork for provider and VFC staff
Improved reporting to CIR
Increased by 70%
Initiated Provider Profile database
Allows identification of poorly performing providers
More timely targeting of these providers
Better program resource management

22. Future Concerns: VMBIP and VODS
Unclear if VODs will require self-reported inventory from providers for accountability
Lower standard than registry-generated DARs
VFC staff must continue to be able to adjust provider orders based on registry-generated DARs
Otherwise our gains will be lost
Registry needs to be leveraged for vaccine ordering, rather than requiring providers to use a new application (VODs)
CIR already familiar to providers
Ordering vaccines through registry will create further incentives for providers to report to and use the registry
Ordering independent of registry undermines vaccine accountability and reporting to registry