Immunization Registry and ProviderReported Vaccination Histories: Assessing Missing Vaccinations - PowerPoint PPT Presentation

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Immunization Registry and ProviderReported Vaccination Histories: Assessing Missing Vaccinations

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To compare vaccination histories obtained from immunization providers and ... Methodology for Identifying Missing Vaccinations ... – PowerPoint PPT presentation

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Title: Immunization Registry and ProviderReported Vaccination Histories: Assessing Missing Vaccinations


1
Immunization Registry and Provider-Reported
Vaccination HistoriesAssessing Missing
Vaccinations
  • Linda Piccinino (Abt Associates, Inc.),
  • Meena Khare (C.D.C.),
  • Mike Battaglia (Abt Associates, Inc.),
  • Diana Bartlett (C.D.C.),
  • Lawrence Barker (C.D.C.)
  • Centers for Disease Control and Prevention
  • 38th National Immunization Conference
  • Abt Associates, Inc.

2
N.I.S. Registry Data Query Study
  • Study integrated registry query consent question
    into standard National Immunization Survey
    (N.I.S.) interview
  • Four mature registry sites participated in the
    study
  • Each site had one quarter of data collection (one
    site in quarter 3 2002, three sites in quarter 4
    2002)
  • Vaccination history data obtained from N.I.S.
    provider reports and from state/local registries
    for children with parental consent

3
Research Problem
  • Need a way to assess the quality of vaccination
    data for N.I.S. children with data available from
    both N.I.S. provider reports and immunization
    registries

4
Objectives of this Analysis
  • To compare vaccination histories obtained from
    immunization providers and registries for a
    sample of N.I.S. children 19 to 35 months old
  • To examine the pattern of missing vaccination
    data by vaccination type, dose and source of data
  • To help identify subgroups of children where
    immunization data were more likely to be absent,
    by characteristics associated with the children
    and their provider types

5
Analysis Groups
  • Sample consisted of N.I.S. children with both
    registry and provider data
  • Data were combined for four sites because of
    sample size and confidentiality concerns
  • For each vaccine type, children were grouped into
    two subgroups of children with
  • provider-reported data but had some missing
    registry data
  • registry-reported data but had some missing
    provider data

6
Methodology for Identifying Missing Vaccinations
  • 323 children with registry vaccination data (at
    least one shot) and adequate provider data in the
    N.I.S.
  • Focus on D.T.a.P. vaccinations present in one
    source but missing from the other source
  • Children U.T.D. with 4 doses of D.T.a.P. in the
    provider data (N equals 245) but fewer than 4
    doses in the registry data (N equals 75)
  • Children U.T.D. with 4 doses of D.T.a.P. in the
    registry data (N equals180) but fewer than 4
    doses in the provider data (N equals 16)
  • Determine dose number (order) of missing
    vaccination

7
Determining the Dose Number of Missing
Vaccinations
  • Provider data
  • February 15, 2001
  • August 12, 2001
  • January 14, 2002
  • September 3, 2002
  • Registry data
  • February 15, 2001
  • January 16, 2002
  • August 30, 2002
  • For each registry vaccination date, determined
    which provider vaccination date was closest in
    time
  • Dose 1
  • Missing
  • Dose 3
  • Dose 4

8
Children with Missing D.T.a.P. Doses
  • Registry 75 Children (30.6 percent)
    Provider 16 Children (8.9 percent)
  • Chart follows Columns 1-4 titled Number of
    missing D.T.a.P. doses of vaccinations in child
    vaccination record
  • Row 1 Missing, Missing, Missing, Missing,
    Registry 10.7 percent and Provider none.Row 2
    Missing, Missing, Missing, Dose 4, Registry 8.0
    percent and Provider 6.3 percent.Row 3
    Missing, Missing, Dose 3, Dose 4, Registry 9.3
    percent and Provider 12.5 percent.Row 4
    Missing, Dose 2, Missing, Missing, Registry 2.7
    percent and Provider none.Row 5 Missing, Dose
    2, Dose 3, Missing, Registry 1.3 percent and
    Provider none.Row 6 Missing, Dose 2, Dose 3,
    Dose 4, Registry 6.7 percent and Provider none.
  • Row 7 Dose 1, Missing, Missing, Missing,
    Registry 6.7 percent and Provider 6.3 percent.
  • Row 8 Dose 1, Missing, Missing, Dose 4, Registry
    6.7 percent and Provider none.
  • Row 9 Dose 1, Missing, Dose 3, Missing, Registry
    5.3 percent and Provider none.
  • Row 10 Dose 1, Missing, Missing, Dose 4,
    Registry 6.7 percent and Provider 18.7 percent.
  • Row 11 Dose 1, Dose 2, Missing, Missing,
    Registry 6.7 percent and Provider 6.3 percent.
  • Row 12 Dose 1, Dose 2, Missing, Dose 4, Registry
    8.0 percent and Provider none.
  • Row 13 Dose 1, Dose 2, Dose 3, Missing, Registry
    21.3 percent and Provider 50.0 percent.
  • Total registry is 100 percent. Total Provider is
    100 percent.

9
Summary of Missing Doses Dose Order
  • Chart
  • Row 1 Order of Missing Doses first dose
    missing, Registry 38.7 percent and Provider
    18.8 percent
  • Row 2 Order of Missing Doses second dose
    missing, Registry 53.4 percent and Provider
    43.8 percent
  • Row 3 Order of Missing Doses third dose
    missing, Registry 49.5 percent and Provider
    18.9 percent
  • Row 4 Order of Missing Doses fourth dose
    missing, Registry 54.7 percent and Provider
    62.6 percent

10
Summary of Missing Doses Dose Frequency
  • Chart
  • Row 1 Number of Missing Doses One dose missing,
    Registry 42.7 percent and Provider 68.7 percent
  • Row 2 Order of Missing Doses Two doses missing,
    Registry 29.3 percent and Provider 18.8 percent
  • Row 3 Order of Missing Doses Three doses
    missing, Registry 17.4 percent and Provider
    12.6 percent
  • Row 4 Order of Missing Doses Four doses
    missing, Registry 10.7 percent and Provider 0.0
    percent

11
Reasons for Missing Provider Doses
  • 23 children had more registry doses than provider
    doses when all vaccines were examined We
    reviewed the Immunization History Questionnaires
    (I.H.Q.) and recontacted the providers when
    necessary. Extra registry vaccination dose was
  • very close to another registry vaccination dose
    date
  • the 4th dose omitted from the I.H.Q. or that
    dose was administered by a provider who did not
    respond to the N.I.S.
  • not the last dose and was inadvertently omitted
    when the I.H.Q. was filled out
  • for a child with multiple providers but household
    respondent only identified one provider
  • for a child for whom not all identified providers
    responded or returned the I.H.Q. with vaccination
    data

12
Characteristics of Children with Missing D.T.a.P.
Doses
  • Row 1 Shot card used during N.I.S. interview
  • Children with Missing Registry Doses (n equals
    75) 68.0 percent
  • Children with Missing Provider Doses (n equals
    16) 31.2 percent
  • Row 2 Child only has private provider or
    providers
  • Children with Missing Registry Doses (n equals
    75) 68.0 percent
  • Children with Missing Provider Doses (n equals
    16) 62.5 percent
  • Row 3 Child has 2 or more providers
  • Children with Missing Registry Doses (n equals
    75) 38.7 percent
  • Children with Missing Provider Doses (n equals
    16) 43.7 percent
  • Row 4 Childs provider reported vaccinations to
    registry
  • Children with Missing Registry Doses (n equals
    75) 65.3 percent
  • Children with Missing Provider Doses (n equals
    16) 68.8 percent

13
Implications for Data Quality
  • Incomplete Vaccination Histories
  • The vaccination histories were not always
    complete.
  • For children with 4 provider doses of D.T.a.P.,
    about 31 percent of children had one or more
    doses missing in the registry data.
  • For children with 4 registry doses of D.T.a.P.,
    only about 9 percent of children had one or more
    doses missing from the provider reports.
  • These suggest that registry histories tended to
    be more incomplete than provider histories.

14
Implications for Data Quality
  • Mixed Pattern of Missing Data
  • The frequency and order of the missing doses for
    D.T.a.P. varied by source of data.
  • Therefore, source of data should be considered
    when interpreting results and making estimates.
  • The fourth D.T.a.P. dose was the most likely to
    be missing in both the provider and registry
    data, although the reasons this 4th dose was
    missing might differ by data source.

15
Implications for Data Quality
  • Special Subgroup Issues
  • Children with multiple providers were more likely
    to have missing provider doses
  • Children with only private providers were more
    likely to have missing registry doses
  • Providers that were not identified by respondents
    might also be responsible for some of the missing
    data
  • A higher percentage of children with missing
    registry data had shot card data than for
    children with missing provider data

16
Conclusion
  • Results may not be conclusive due to the small
    sample size.
  • Results showed a mixed pattern of missing doses.
  • Data quality concerns suggest that building
    combined best value estimates may be difficult
    since the quality and completeness of registry
    data are lacking.
  • Although there are data quality problems, some
    registries were more complete than others.
  • Results strongly support further research on
    supplementing provider-reported immunization
    histories with registry data in order to improve
    vaccination coverage estimates.

17
Next Step
  • Future research plans include looking at the
    quality of registry data compared to
    household-reported vaccination data from shot
    cards
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