When the Law Fails, Try Humor and Bribery Obtaining Clean Data

1
When the Law Fails, Try Humor and Bribery
Obtaining Clean Data

• The CT Immunization Registry and
• Tracking System (CIRTS)
• The State of CT Department of
  Public Health
• Joan Christison-Lagay, CIRTS Consultant
• Michael Tommasi, CT DPH
• Nancy Caruk, CT DPH

2
An Art, Not a Science

• Obtaining clean data is an art, not a
  science.
• Many approaches must be used.
  
• In l994, CT passed
  legislation
• requiring pediatric and
  family
• practices to submit
  immunization histories to the State DPH. Despite
  the legislative mandate, not all practices
  reported in a timely fashion. A few failed to
  report at all.
• The law alone was insufficient.

3
Humor

• Initial monthly letters were factual
• and dry staff suspected that many
• went unread. Monthly letters
• now begin with humor. Examples
• (these from middle school science exams)
• Three kinds of blood vessels are arteries, vanes
  and caterpillars
• The body consists of three parts the brainium,
  the borax and the abominable cavity. The
  brainium contains the brain, the borax contains
  the heart and lungs, and the abominable cavity
  contains the bowels, of which there are five
  a,e,i, o and u.

4
Bribery

• A Pediatric Practice of the Week coffee cake
  award was instituted in different categories
  e.g., for consistent on-time reporting
• Cheap! Only 25/week or 1300/year which is much
  less than brochures
• Great response from office staff
• Im drooling, how can we win?

5
Persistence

• Despite the law, humor and
• bribery, a few practices still
• fail to submit monthly data.
• CIRTS seeks out missing reports
• through persistent phone calls.
• The monthly report is not complete until all 469
• public and private practices in CT have submitted
• data. Nineteen IAP coordinators statewide help
• track reports and children.

6
De-duplication

• De-duplication remains a time-consuming
  problem which has not been perfected by CIRTS.
  Last names on automatic feeds such as birth
  certificates and Medicaid files often do not
  match. To address this, CIRTS runs reports that
  look for children with the same first name and
  date of birth.

7
A Last Chance

• At the end of every calendar year
• Medicaid Plans are sent a list of their children
  with no or few visits to the PCP on record.
  Plans check claims and provide CIRTS the latest
  PCP.
• All practices receive a report specifying which
  immunizations are missing on individual children.
  Practices have one month to submit clean-up data.

8
The Results of CIRTSEfforts Clean Data

• CIRTS has enrolled more than 80 of all CT
  newborns since l999
• CIRTS obtained immunizations other than Hep 1 on
  80 of all children born in 2000
• DATA are complete and clean enough to run
• HEDIS reports for all 2 year old Medicaid
  children
• Immunization status reports for all practices in
  CT
• Special reports e.g., effects of DTaP shortage

9
Comparison of CT Registry Data and NIS Data

• CIRTS Children Born Jan-Dec 2000
• Immunization rates
• 89.5 of birth cohort excluding
  moved, deceased, adopted refusals

10
Special Reporting CapabilityExample Inferences
Drawn on Possible Effect of DTaP Shortage--Rates
With Without a 6 Month Grace Period

• Preliminary data

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Challenges to Meet

• 42,659 children were born in CT in 2000
• 1,737 (4.1) moved, died or were adopted by age 2
• 40,922 were potential enrollees at age 2 but only
  34,111 (83.4) were enrolled. Non-enrollees
  included refusals and those on whom no enrollment
  form was received.

12
Challenges to Meet

• 2,783 (7.2) of 38,519 parents elected to opt-out
• 4,028 (9.5) of parents submitted no form. CIRTS
  was unsure if they had received a form or not.
  Challenges to CIRTS
• work with providers to convince parents to
  rescind the refusal given at birth
• ensure that all parents receive an enrollment
  form, perhaps through a mailing. This would
  enable CT to exercise its opt-out law.