1. Searching for Pockets of Need: Using Registry Data and GIS Mapping to Identify Immunization Coverage Levels Kevin Czubachowski, Immunization Field Rep., MDCH Kyle Enger, Epidemiologist, MDCH Priya Nair, Epidemiologist, Genesee Co. Health Dept. Wendy Nye, Region 4 MCIR, Genesee Co. Health Dept.

2. Region 4 MCIR Michigan separated into six regions Michigan separated into six regions Region 4 covers 9 “thumb” countiesRegion 4 covers 9 “thumb” counties Region charged with: Region charged with: Training and provider complianceTraining and provider compliance Monitoring provider/county ratesMonitoring provider/county rates Maintaining provider databaseMaintaining provider database Participation in local iz coalitionsParticipation in local iz coalitions Assisting LHDs with accreditationAssisting LHDs with accreditation Collaborating with LHDs and providersCollaborating with LHDs and providers

3. Looking for Pockets of Need Idea generated by Genesee County Partnership for Immunizations Idea generated by Genesee County Partnership for Immunizations Data and Assessment subcommitteeData and Assessment subcommittee Proposal to the State of Michigan Proposal to the State of Michigan Use of registry data as well as regional provider database Use of registry data as well as regional provider database Region pulled initial data Region pulled initial data Deduplicated data prior to final pullDeduplicated data prior to final pull

4. Stages in the mapping process Data pull Data pull Genesee Co. residents turning 2 yrs. old in 2002Genesee Co. residents turning 2 yrs. old in 2002 Immunizations given on/before 12/31/02Immunizations given on/before 12/31/02 Data cleaning and recoding Data cleaning and recoding DeduplicationDeduplication Immunization data cleaning and recodingImmunization data cleaning and recoding Address data cleaningAddress data cleaning Geocoding Geocoding Mapping (still in progress) Mapping (still in progress) Analysis/interpretation (still in progress) Analysis/interpretation (still in progress)

5. Data Cleaning Process (used SAS 8, ArcView 8.3) Immunizations Immunizations Separate antigensSeparate antigens Delete obvious invalid dosesDelete obvious invalid doses Imms given before 6 wks except Hep B Imms given before 6 wks except Hep B MMR & Var < 1 yr. MMR & Var < 1 yr. If same antigen given < 4 wks apart, 2 nd deleted If same antigen given < 4 wks apart, 2 nd deleted Some invalid doses remainSome invalid doses remain Missing dataMissing data Addresses Addresses Used resp. party data Error correction Correct street errors Check/correct ZIPs Remove unnecessary address data Geocode Check & correct unmatched addresses Re-geocode

6. Sources of Error (and how they were addressed) Geocode errors Geocode errors Extensive address data cleaningExtensive address data cleaning Consulted local GIS expertConsulted local GIS expert Map framework errors Map framework errors Most recent road data (release 8/5/03)Most recent road data (release 8/5/03) Immunization/record errors Immunization/record errors Removed many invalid shots, but not allRemoved many invalid shots, but not all # shots missing unclear and varies by location; registry not yet complete# shots missing unclear and varies by location; registry not yet complete Child-level errors Child-level errors Studied 2 yr. olds,  addresses updatedStudied 2 yr. olds,  addresses updated Records de-duplicatedRecords de-duplicated

10. 43133 Map Interpretation Highest rates have lowest population Highest rates have lowest population Most census tracts have coverage rates of 60-75% of 2 yr. olds Most census tracts have coverage rates of 60-75% of 2 yr. olds Further analysis will determine: Further analysis will determine: Medical homeMedical home Barriers to care/resources availableBarriers to care/resources available Economic level of communityEconomic level of community Provider data completenessProvider data completeness Completeness vs. Iz Coverage Completeness vs. Iz Coverage

11. Future Directions Sharing information Sharing information Relationship of medical home to geography Relationship of medical home to geography Use census data to find factors associated with iz. coverage Use census data to find factors associated with iz. coverage Use information to increase coverage Use information to increase coverage

12. Lessons Learned… Data overload (Pandora’s Box)!!! Data overload (Pandora’s Box)!!! Over 200 person hours Over 200 person hours Analysis leads to data quality improvement Analysis leads to data quality improvement High level of GIS expertise helpful, but not necessary High level of GIS expertise helpful, but not necessary

13. Acknowledgements Pam Kowalske, Region 4 MCIR Pam Kowalske, Region 4 MCIR Pete Apgar, Genesee County Equalization Pete Apgar, Genesee County Equalization Bobby Pestronk, Genesee County Health Department Bobby Pestronk, Genesee County Health Department Bob Swanson, Manager of Assessment and Local Support, MDCH Bob Swanson, Manager of Assessment and Local Support, MDCH

14. Contact Information Kyle Enger, Epidemiologist, MDCH Kyle Enger, Epidemiologist, MDCH engerk@michigan.govengerk@michigan.govengerk@michigan.gov Kevin Czubachowski, Immunization Field Rep., MDCH Kevin Czubachowski, Immunization Field Rep., MDCH czubachowskik@michigan.govczubachowskik@michigan.govczubachowskik@michigan.gov Wendy Nye, Region 4 MCIR Wendy Nye, Region 4 MCIR wnye@co.genesee.mi.uswnye@co.genesee.mi.uswnye@co.genesee.mi.us Priya Nair, Genesee Co. Health Dept. Priya Nair, Genesee Co. Health Dept. pnair@co.genesee.mi.uspnair@co.genesee.mi.us