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The relationship between immunization registry operational status and accuracy of vaccination covera

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Establish registry record within 2 months of birth for each child in catchment area ... A registry with at least 80% saturation and functionality tend to provide ... – PowerPoint PPT presentation

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Title: The relationship between immunization registry operational status and accuracy of vaccination covera


1
The relationship between immunization registry
operational status and accuracy of vaccination
coverage estimates among children aged 19-35
months
  • Diana Bartlett1, Gary Urquhart2, and Robb Linkins2

1 Association of Schools of Public Health 2
Centers for Disease Control and Prevention
2
Overview
  • Background
  • CDC/NIP 1999 Immunization Registry Annual Report
  • National Immunization Survey (NIS)
  • Study objectives
  • Methods
  • Results
  • Recommendations

3
Background
  • The CDC/NIP 1999 Immunization Registry Annual
    Report provides self-reported registry
    development data from 62 projects
  • The report measures child and health provider
    enrollment, possession of 12 core registry
    functional attributes, and vaccination coverage

4
Background
  • Registries are a potential source of estimates of
    population-based childhood vaccination coverage
  • Currently, the NIS is the only source of reliable
    estimates of national/state/urban area infant
    vaccination coverage that can be compared across
    sites

5
Objectives
  • Evaluate whether there is agreement between
    immunization coverage based on registry data and
    a gold standard
  • Evaluate whether agreement varies by operational
    status
  • Describe another means of assessing registry
    functionality through accuracy of vaccination
    coverage

6
Methods
  • CDC/NIP 1999 Immunization Registry Annual Report
  • Self-reported data current as of April 1999
  • 26 projects assessed 431 coverage of infants
    19-35 months
  • Projects grouped by registry saturation ( of
    eligible children enrolled in registry) and
    registry functionality (based on 12 core
    functions) into high, medium, and low operational
    status

7
Methods
  • 12 core functions include
  • Electronically store NVAC data
  • Establish registry record within 2 months of
    birth for each child in catchment area
  • Enable providers to retrieve immunization records
    at the time of encounter with child
  • Ensure that providers submit information within
    one month of administering vaccine

8
Methods
  • 12 core functions include
  • Have confidentiality and security measures in
    place to protect medical information
  • Ability to recover lost data
  • Exchange immunization using HL7 standards
  • Identify needed vaccines when child presents for
    a vaccination
  • Identify patients overdue for vaccinations

9
Methods
  • 12 core functions include
  • Automatically produce vaccination coverage
    reports by providers, age group, and geographic
    area
  • Produce authorized immunization records
  • Consolidate immunization records from all health
    providers to decrease deduplication and optimize
    data accuracy

10
Methods
  • Registry projects assessing 431 vaccination
    estimates included
  • 22 states AL, AK, AZ, DE, IL, KS, MA, MI, MO,
    NE, NH, NJ, ND, OH, OK, RI, SC, SD, TN, TX, UT,
    WA
  • 4 district/city registries the District of
    Columbia, New York City, Philadelphia, and
    San Antonio

11
Methods
  • High operational status 80 in both registry
    saturation and functionality (Arizona and San
    Antonio)
  • Medium operational status 50-79 (22
    projects)
  • Low operational status lt50 in both registry
    saturation and functionality (South
    Carolina and Utah)

12
Methods
  • NIS is a random-digit-dialed telephone survey
    that uses parental report and a provider record
    check to assess vaccination coverage of infants
    aged 19-35 months
  • NIS vaccination rates from July 1998-June 1999
    used

13
Methods
  • Registry project 431 population coverage rates
    compared with NIS vaccination rates for project
    areas by operational status
  • Registry coverage infants with 431 coverage
    in the registry/ of infants in the state
  • Vaccination rate differences analyzed using SAS
    6.12 and the Wilcoxon rank sum test (equality of
    medians test)

14
Results
  • Registry 431 vaccination coverage estimates
    varied widely
  • High operational status 58.9-89.1
  • Medium operational status 1.5-72.3
  • Low operational status 8.9-18.5

15
Results
16
Results
  • The median absolute differences between NIS and
    registry estimates were
  • 12.6 for high operational status projects
  • N2, Range 11.1-14.1
  • 65.7 for medium operational status
  • N22, Range6.7-87.5
  • 68.8 for low operational status projects
  • N2, Range 66.5-71.1

17
Conclusions
  • Registries with a high operational status have
    closer agreement between vaccination coverage
    estimates in the NIS and registry data
  • Equality of medians test (Wilcoxon rank test had
    a p-value of 0.1, suggesting that medians might
    not be equal)
  • Despite low operational status, population
    vaccination coverage is not compromised

18
Conclusions
  • Registries may not yet have sufficient
    functionality and enrollment to accurately assess
    population-based vaccination coverage
  • A registry with at least 80 saturation and
    functionality tend to provide coverage estimates
    closer to those of the NIS than registries will a
    lesser operational status

19
Limitations
  • The sample sizes are small and not distributed
    evenly among the operational status groups
  • Registries that have low saturation rates may
    provide less accurate estimates of vaccination
    coverage in the population

20
Recommendations
  • Vaccination coverage estimate agreement should be
    added as a measure of registry functionality
  • Reporting periods in registry saturation and
    functionality assessment should be standardized

21
Recommendations
  • Continue monitoring registry data quality and
    completeness to discern the reasons for the
    NIS-registry data vaccination estimate
    differences
  • Until registries have high functionality and data
    quality, policy makers should be cautious when
    interpreting registry data in decision making
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