Immunization Reminder-Recall Project

1. Collaboration Project Between 3 Provider Sites and: Immunization Reminder-Recall Project

2. Team Members

3. PLANUnderstand the system – what we know • Healthy People 2010 goal = 80%* • Washington State’s immunization rate is 71.4%(2006 National Immunization Survey)* • Only 36% of children have up-to-date records in Child Profile’s Immunization Registry (2006) * • Multiple articles and best practice indicate reminder-recall • “Patient reminder systems in primary care settings are effective in improving immunization rates. Primary care physicians should use patient reminders to improve immunization delivery”.1 *Immunization rates are based on the 4:3:1:3:3:1 vaccine series (4DTaP, 3Polio, 1MMR, 3HIB, 3HepB, 1Var) 1. Szilagyi, P.G., Bordley, Clayton, Vann, J.C., Chelminski, Ann, Kraus, R.M., Macrgolis, P.A., & Rodewald, L.E. Effect of Patient Reminder/Recall Interventions on Immunization Rates. Journal of American Medical Associates, Vol. 284 No. 14, October 11, 2000. ² National, state and local area vaccination coverage among children aged 19-35 months—United States, 2006. MMWR Morbidity Mortality Weekly Report 2007;56:880-5.

4. PLAN -Analyze the causes - fish bone

5. PLANDefine the opportunity –Project goals and aim • Increase the number of children, 19 – 35 months old, who are fully immunized* in the provider setting. • Increase the amount of current and accurate data* in the immunization registry. • Increase provider usage of Washington State’s Immunization Registry: CHILD Profile. • *Immunization rates are based on the 4:3:1:3:3:1 vaccine series (4DTaP, 3Polio, 1MMR, 3HIB, 3HepB, 1Var). Snohomish also added 2HepA to their analysis.

6. PLANSelected 3 provider sites to conduct pilot Provider Site Criteria • Currently using CHILD Profile Immunization Registry • Does not have a current reminder/recall process in place • Is or willing to enter historical data into the registry • Is or willing to inactivate patients, in the registry, that are no longer their patient

7. Provider Office Profiles

8. PLANEvaluation methods Data Sources • CHILD Profile Immunization Data • CDC’s CoCASA Program that allows a provider office to assess their clinic immunization rate • Tracking Sheet for clinic use Use collected data to answer: • Did the project increase the number of children 19-35 months old who are fully immunized? • Did the project improve current data in the registry? • Did the project improve use of the Immunization Registry? • Will the provider continue with reminder/recall system? • What frequency should reminder/recall occur?

9. Do - Project Timeline

10. Project Timeline Continued

11. Study Results – Pediatric Practice: Snohomish Co.Compare results – fully immunized and current/accurate data in the registry. 843in Cohort 865in Cohort 942in Cohort 843 in Cohort

12. Study Results – Pediatric Practice: Snohomish Co.Model Number II – 2 doses of HepA results 843 in Cohort

13. Study Results – Pediatric Office: Spokane CountyCompare results – fully immunized and current/accurate data in the registry. 353 in Cohort 362 in Cohort 388 in Cohort 353in Cohort

14. Study Results– Family Practice Office: Spokane Co.Compare results – fully immunized and current/accurate data in the registry. 39in Cohort 41in Cohort 41in Cohort 39 in Cohort 9 weeks as of 12/31/2007–Preliminary Data

15. STUDY -Lessons Learned

16. ACT -standardize the improvement

17. ACTReflect and establish future plans • Check back with pilot sites to determine if they will continue to send reminders based on CHILD Profile Immunization Registry data • Share project with other LHJs – good basis for local health indicator work and performance measures • Continue to conduct project with other provider offices • Depends on resources – incorporate lessons learned to make the project manageable within available resources