Kevin Czubachowski, Immunization Field Rep., MDCH Kyle Enger, Epidemiologist, MDCH

1. Searching for Pockets of Need: Using Registry Data and GIS Mapping to Identify Immunization Coverage Levels Kevin Czubachowski, Immunization Field Rep., MDCH Kyle Enger, Epidemiologist, MDCH Priya Nair, Epidemiologist, Genesee Co. Health Dept. Wendy Nye, Region 4 MCIR, Genesee Co. Health Dept.

2. Region 4 MCIR • Michigan separated into six regions • Region 4 covers 9 “thumb” counties • Region charged with: • Training and provider compliance • Monitoring provider/county rates • Maintaining provider database • Participation in local iz coalitions • Assisting LHDs with accreditation • Collaborating with LHDs and providers

3. Looking for Pockets of Need • Idea generated by Genesee County Partnership for Immunizations • Data and Assessment subcommittee • Proposal to the State of Michigan • Use of registry data as well as regional provider database • Region pulled initial data • Deduplicated data prior to final pull

4. Stages in the mapping process • Data pull • Genesee Co. residents turning 2 yrs. old in 2002 • Immunizations given on/before 12/31/02 • Data cleaning and recoding • Deduplication • Immunization data cleaning and recoding • Address data cleaning • Geocoding • Mapping (still in progress) • Analysis/interpretation (still in progress)

5. Immunizations Separate antigens Delete obvious invalid doses Imms given before 6 wks except Hep B MMR & Var < 1 yr. If same antigen given < 4 wks apart, 2nd deleted Some invalid doses remain Missing data Addresses Used resp. party data Error correction Correct street errors Check/correct ZIPs Remove unnecessary address data Geocode Check & correct unmatched addresses Re-geocode Data Cleaning Process(used SAS 8, ArcView 8.3)

6. Sources of Error(and how they were addressed) • Geocode errors • Extensive address data cleaning • Consulted local GIS expert • Map framework errors • Most recent road data (release 8/5/03) • Immunization/record errors • Removed many invalid shots, but not all • # shots missing unclear and varies by location; registry not yet complete • Child-level errors • Studied 2 yr. olds,  addresses updated • Records de-duplicated

10. 43133 Map Interpretation • Highest rates have lowest population • Most census tracts have coverage rates of 60-75% of 2 yr. olds • Further analysis will determine: • Medical home • Barriers to care/resources available • Economic level of community • Provider data completeness • Completeness vs. Iz Coverage

11. Future Directions • Sharing information • Relationship of medical home to geography • Use census data to find factors associated with iz. coverage • Use information to increase coverage

12. Lessons Learned… • Data overload (Pandora’s Box)!!! • Over 200 person hours • Analysis leads to data quality improvement • High level of GIS expertise helpful, but not necessary

13. Acknowledgements • Pam Kowalske, Region 4 MCIR • Pete Apgar, Genesee County Equalization • Bobby Pestronk, Genesee County Health Department • Bob Swanson, Manager of Assessment and Local Support, MDCH

14. Contact Information • Kyle Enger, Epidemiologist, MDCH • engerk@michigan.gov • Kevin Czubachowski, Immunization Field Rep., MDCH • czubachowskik@michigan.gov • Wendy Nye, Region 4 MCIR • wnye@co.genesee.mi.us • Priya Nair, Genesee Co. Health Dept. • pnair@co.genesee.mi.us