Increasing Registry Value Through Partnerships

National Immunization Registry ConferenceAtlanta, GeorgiaOctober 28, 2003

Debbie McCune DavisThe Arizona Partnership for Immunization

A Statewide Registry…the original vision

• Improve interaction between providers and families to increase immunizations of children.

• Establish a single site for storage of childhood immunization information.

• Complete records available of child’s immunization status.

• All providers participate, and have access to up to date immunization records.

Partners

• Arizona Department of Health Services• Arizona Health Care Cost Containment

System (AHCCCS)• County Health Departments• Arizona Community Health Centers• Commercial Health Plans• Private Providers• Municipal Fire Departments• Department of Economic Security• Schools and Day Care Centers

Expand sphere of influence through partnerships

Community Health Centers

Managed Care Plans

Arizona Medical Assn.

AHCCCS and Health Plans

ADHS and Counties

Medicaid Managed Care4:3:1 – 78.1% 2001

• Mercy Care– 80.7%– 1,280 Sample size

• Phoenix Health Plan – 83.5%– 558 Sample size

0

20

40

60

80

100

1998 1999 2000 2001

4:3:1 Series 4:3:1:2:3 Series 6 Well-child Visits >15 Months

Annual Trend in Immunization Rates and Well-child Visits,Children Enrolled in AHCCCS (TXIX)P

erce

nt

Community Health CentersMountain Park Community Health

Center– May 2002 – 1,276 AHCCCS Kids– 94% coverage levels

Uses ASIIS for quarterly assessments

Identifies high risk patients for recall during flu season - 384 children.

Coordination with school nurses resulted in 25% fewer referrals of 10 – 14 year olds.

WIC/Immunization Collaboration

Shared Vision• To Improve Immunization

Coverage Rates• Develop Strategies that

Manage Barriers• Maximize Cost

Effectiveness• Present a Model that

works in diverse WIC settings

The Learning Curve

0102030405060708090

1997 1998 1999 2000

Mesa Guadalupe Scottsdale

Getting Down to Business

47%

75%

39%

68%

57%

42%48% 46%

68%74%

40%

64%

54%

76%69%

1999 2000 2001 2002 20030%

20%

40%

60%

80%

100%Mesa Guadalupe Scottsdale

Maricopa County WIC Sites1999-2003 Coverage Levels of 24 to 35 Month Olds

Source: 1999-2003 CASA Assessment Reports.Prepared by: ADHS Immunization Program Office, Assessment Unit.

Commercial Managed Care

CIGNA Medical Group – Adolescent Initiative

Results/Benchmarks/Goals Adolescents

Statewide-Commercial

1998 1999 2000 Goal

2001

Bench-mark

MMR + HepB 18.60% 21.70% 35.77% 40% 46%

HEDIS Top10%

MMR 44.72 % 50.12% 62.29% 67% 86.18%

QualityCompass Rep.

Hepatitis B 22.46% 24.33% 39.17% 57% 68.61%

QualiltyiCompass Rep

Varicella 21.96% 22.14% 25.79% 40% 54.57%

QualityCompass Rep

School Nurses

“The first time I used the ASIIS website, I resolved 37 student immunization issues. That meant students whose school registrations were not delayed because of problems with their immunization record. With a daily enrollment of over 750, I can use all the help I can get!”

Suzanne Boyd, MS,RN

Tucson Unified School District

SE Maricopa County

Phoenix Fire Baby Shots Program

“In 2002, we saw 6317 children and provided 13,376 immunizations in our clinics. The majority of children are from Spanish speaking households. All shots were entered into the registry.” • Sheri Gibbons, Phoenix

Fire Department

County Health Departments

“To date we have saved $13,780.75 by searching ASIIS for missing immunizations.

This total represents a one month tally at three of our locations.”

Machrina Smith, RN Maricopa County

Child Protective Services

“We average 2-5 requests a day from CPS workers for immunization records. Children have been removed from their homes and must be placed in foster care. Having easy access to immunization records makes it easier to place children with foster parents because there is no barrier to school or day care and no need for a doctor’s appointment to get unneeded shots”

Andie Denious, RN

Rural County in Crisis

Rodeo-Chedeski Fire – Navajo County – Summer 2002

“Roughly 25,000 residents were displaced as the fire destroyed 250 homes and burned 468,000 acres. Community health workers used the registry to organize tetanus shot clinics. Parents were provided with documentation of past immunizations to ensure re-admittance of children to school.”

Arizona State Immunization Information System

Total patients 2,058,909Total immunizations 16,115,939

Compliance with Healthy People 2010 95% patients under 6 in registry

Enrollment 3,251 users/497 sites School/Day Care 1355 users/100+sites

Changing Medical Practice to Change Lives

Current medical environment:• Rising Costs• Population Growth• Change in Demographics and utilization patterns• Workforce issues• Emergency Department – 15% increase • Increased medical expectations

Registries play a role in meeting every challenge!