Transcript Document 7503445

Utility of a Regional Immunization
Registry in a Pediatric Emergency
Department
Collaboration between
SUNY Upstate Medical University,
Onondaga County Health Department and
CNY Immunization Registry
Authors
CNY Immunization Registry
 Katie Reed, MPA
SUNY Upstate Medical University
 Jim Callahan, MD, FAAP, FACEP
 David Reed, MD, FACEP
 Victoria Meguid, MD, FAAP
 Susan Wojcik, MS
Onondaga County Health Department
 Cynthia O’Connor, MPA
Medical Students Participating
SUNY Upstate Medical University
 Michael Danca
 Shari Goldfarb
 Toni Torrillo
 Amit Kumar
For Patients treated in a Pediatric
Emergency Department
1. Can a registry be accessed during real-time ED
care to determine immunization status?
A. Prevalence of registry patients in the ED?
B. Immunization status per registry?
C. Rate of parental agreement with registry?
Healthy People 2010
“Population-based immunization registries
will be a cornerstone of the nation’s
immunization system by the year 2010”
 Link health care providers with
immunization partners such as HMO, WIC,
etc…
 95% of all children under the age of six will
be in an immunization registry.
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Prior Investigations
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Randomized Study of Tracking with Outreach and
Provider Prompting to Improved Immunization
Coverage and Primary Care. Rodewald LE, et. al.,
University of Rochester, New York, in Pediatrics,
Jan 1999
Providing Immunizations in a Pediatric
Emergency Department: Under-immunization
Rates and Parental Acceptance. Cunningham SJ,
Jacobi Medical Center, Bronx, in Pediatric
Emergency Care, August 1999
CNY Immunization Registry
Regional registry, part of NYSIIS
 Population-based 14 county region
 Data collection began in 1998
 Voluntary physician participation
 Signed consent required

0
Jan-02
Nov-01
Sep-01
Jul-01
May-01
Mar-01
Jan-01
Nov-00
Sep-00
Jul-00
May-00
Mar-00
Jan-00
Nov-99
Sep-99
Jul-99
May-99
35000
Mar-99
40000
Jan-99
Nov-98
Sep-98
Jul-98
May-98
Mar-98
Number of Children Consented Regionally
45000
Born Prior to 1996
Born 1996 - 2001
30000
25000
20000
15000
10000
5000
14 County Saturation
NYSDOH July, 2001
Primary Target Area Saturation
NYSDOH July 2001
Study Setting
CNY population 1.5 million
 Syracuse MSA 735,000
 Regional University Pediatric Emergency
Department (17,530 visits)
 Designated tertiary pediatric ED (54% of all
peds ED visits to Syracuse Hospitals)
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Methods
Approved by IRB
 Study Design: Prospective, observational,
cohort study of ED patients 10 and younger
 Study Period: 7 weeks of summer 2001
 Convenience sample 10A-MN (95% of
volume)
 Interviews performed by medical students
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Registry Access
Study site affiliated with University
Pediatric and Adolescent Center
 Facilitated access from pediatric internal
database with regional database, due to lack
of modem access
 Trained medical student to query and print
immunization history report using
HealthyShot, registry software
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ACIP Recommended Immunization Schedule
Hepatitis B
HIB
DTaP
IPV
MMR
Varicella
2m
4m
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6m
12 m 15 m
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4-6 y
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Patient Considered Up-To-Date
Hepatitis B
HIB
DTaP
IPV
MMR
4m
6m
1
1
1
1
2
2
2
2
8 m 14 m 24 m
2
2
3
2
2
2
3
2
1
3
3
4
3
1
6y
3
3
5
4
2
Results
Sample
Consented to participate
Patients Enrolled in IR
720
698 (97%)
235 (34%)
Results
Patients Enrolled in IR
Under age 2
Aware of IR Enrollment
PCP
Private Practice
Clinic
Unknown
Immunizations
Up-To-Date
Parental Report
IR Documented
235 (34%)
85 (36%) 95% CI; 30-42%
67 (29%) 95% CI; 23-34%
67 (29%) 95% CI; 23-34 %
146 (62%) 95% CI; 56-68%
22 (9%)
225 (96%) 95% CI; 93-98%
143(61%) 95% CI; 55-67%
Individual Immunization Deficiencies
Underimmunized – 92 (39%) of 235
Missing
Not UTD on 1 Immunization – 30 (33%)
Hep B
HIB
DTaP
IPV
MMR
n
9
9
2
1
9
Not UTD on 2 Immunization – 14 (15%)
Hep B/HIB
Hep B/DTaP
Hep B/MMR
HIB/DTaP
HIB/MMR
DTaP/MMR
4
2
1
2
1
4
Not UTD on 3 Immunization – 8 (9%)
Hep B/HIB/DTaP
Hep B/DtaP/IPV
HIB/DtaP/IPV
HIB/DtaP/MMR
DTaP/IPV/MMR
1
1
1
3
2
Not UTD on 4-5 Immunization – 40 (43%)
Hep B/HIB/DTaP/IPV
Hep B/DTaP/IPV/MMR
HIB/DTaP/IPV/MMR
Hep B/HIB/DTaP/IPV/MMR
13
3
1
23
Conclusions
Real-time access was possible in an ED
 34% of the children were in CNYIR
 39% were documented to have
immunization deficiencies
 Only 26% were aware of IR enrollment
 ED-PCP or outreach communication after
an ED visit may improve identification of
under-immunized patients
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Next Steps
Continue to work on efforts to encourage
data quality reviews at the providers sites.
 Continue public awareness campaign to
parents/guardians about IR
 Establish mechanism for follow up to kids
indicating immunization deficiencies.
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Contact Information
Katie Reed
Director, Public Health
Partners In Health Systems
PO Box 249
5703 Enterprise Parkway
Dewitt, NY 13214
315-446-1612 ext 7217
[email protected]