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Point of Service vs. Real Time Registry-based Coverage Assessment

Point of Service vs. Real Time Registry-based Coverage Assessment. M. Irigoyen, S. Findley, S. Chen, F. Chimkin, O. Peña Northern Manhattan Immunization Partnership Columbia University, New York, NY. Background.

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Point of Service vs. Real Time Registry-based Coverage Assessment

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  1. Point of Service vs. Real Time Registry-based Coverage Assessment M. Irigoyen, S. Findley, S. Chen,F. Chimkin, O. Peña Northern Manhattan Immunization Partnership Columbia University, New York, NY

  2. Background • Immunization registries are expected to include all immunizations, but this may not be the case • Discrepancy in coverage rates assessed at different points in time may highlight problems in registry completeness

  3. Objective • To compare registry-based coverage rates assessed at two points in time: real time (assessment date) and last point of service (last visit)

  4. Organizational Setting • Northern Manhattan Immunization Partnership (NMIP), NYC, a CDC funded demonstration project • NMIP developed a regional registry to facilitate sharing of records among practices and expedite upload to city immunization registry

  5. Ez VAC Registry EzVAC Registry New York Presbyterian Hospital Ambulatory Care Network School Based Clinics Community Providers NYC DOH Citywide Immunization Registry

  6. NMIP Immunization Registry • Private registry for Northern Manhattan • Web-based and real time • Regular downloads to NY Citywide Immunization Registry • Launched March 1999 • Currently at 30+ practices, 120,000+ children • 98% vaccine capture rate

  7. Study Population • Latino and low income children 6-23 months, • 5 hospital-affiliated practices in Northern Manhattan, NYC

  8. Eligibility Criteria • born after registry rollout • ages 6-23 months at assessment • 1+ visit to the practice • age of last visit >3 months • 1+ immunizations in registry

  9. Assessment Methods Compared • Coverage rates at two points in time: • an assessment date (10/01/01 and 04/01/02 • the last point of service (visit) prior to the assessment date • n = 4,725

  10. Last visit Child N. H. Last visit Child M.O. Last visit Child I. P. Last visit Child P. E. Time Last Point of Service (last visit) vs. Date of Assessment (four examples) Assessment Date (04-01-02)

  11. Outcomes • DTaP:Polio:MMR:Hib:HepB (4:3:1:3:3) age-appropriate immunization coverage rates at assessment date and at last point of service (last visit)

  12. Comparison of Coverage Rates (6-11 months Old) ** *** ** p < .01 ***p < .001

  13. Comparison of Coverage Rates (12-23 months Old) *** *** ***p < .001

  14. Conclusion • The difference may be due to record scatter or disengagement from care. • Regular sharing of records between registries is needed to ensure accurate immunization assessments. • Registry generated reminder/recall can help decrease disengagement and narrow the gap between estimates.

  15. Implications • Registry-based assessments at an assessment date and at last point of service (last visit) offer complementary perspectives on vaccine delivery and documentation that can guide registry quality improvement

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