Utility of a Regional Immunization Registry in a Pediatric Emergency Department

1. 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

2. 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

3. Medical Students Participating SUNY Upstate Medical University • Michael Danca • Shari Goldfarb • Toni Torrillo • Amit Kumar

4. 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?

5. 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.

6. Prior Investigations • 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

7. CNY Immunization Registry • Regional registry, part of NYSIIS • Population-based 14 county region • Data collection began in 1998 • Voluntary physician participation • Signed consent required

8. Number of Children Consented Regionally

9. 14 County Saturation NYSDOH July, 2001

10. Primary Target Area Saturation NYSDOH July 2001

11. 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)

12. 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

13. 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

15. Results

16. Results

17. Individual Immunization Deficiencies

18. 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

19. 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.

20. 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 kreed@phs-us.com