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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METHODOLOGY FOR IDENTIFYING MISSING VACCINATIONS ... Focus on DTaP vaccinations present in one source but missing from the other source ... – 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), Meena Khare
    (CDC), Mike Battaglia (Abt Associates), Diana
    Bartlett (CDC), Lawrence Barker (CDC)

2
NIS REGISTRY DATA QUERY STUDY
  • Study integrated registry query consent question
    into standard National Immunization Survey (NIS)
    interview
  • Four mature registry sites participated in the
    study
  • Each site had one quarter of data collection (one
    site in Q3/2002, three sites in Q4/2002)
  • Vaccination history data obtained from NIS
    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 NIS children with data available from
    both NIS provider reports and immunization
    registries

4
OBJECTIVES OF THIS ANALYSIS
  • To compare vaccination histories obtained from
    immunization providers and registries for a
    sample of NIS children 19-35 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 NIS 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
    NIS
  • Focus on DTaP vaccinations present in one source
    but missing from the other source
  • Children UTD with 4 doses of DTaP in the provider
    data (N 245) but fewer than 4 doses in the
    registry data (N 75)
  • Children UTD with 4 doses of DTaP in the registry
    data (N 180) but fewer than 4 doses in the
    provider data (N 16)
  • Determine dose number (order) of missing
    vaccination(s)

7
DETERMINING THE DOSE NUMBER OF MISSING
VACCINATIONS
  • Provider data
  • (1) 2/15/2001 (2) 8/12/2001 (3) 1/14/2002 (4)
    9/03/2002
  • Registry data
  • 2/15/2001 1/16/2002 8/30/2002
  • 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 DTaP DOSES
  • REGISTRY 75 CHILDREN (30.6)
    PROVIDER 16 CHILDREN (8.9)

9
CHILDREN WITH MISSING DTaP DOSES, contd
  • REGISTRY 75 CHILDREN (30.6)
    PROVIDER 16 CHILDREN (8.9)

10
SUMMARY OF MISSING DOSES Dose Order

11
SUMMARY OF MISSING DOSES Dose Frequency

12
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
    (IHQs) 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 IHQ or that dose
    was administered by a provider who did not
    respond to the NIS
  • not the last dose and was inadvertently omitted
    when the IHQ 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 IHQ with vaccination
    data

13
CHARACTERISTICS OF CHILDREN WITH MISSING DTaP
DOSES
14
IMPLICATIONS FOR DATA QUALITY
  • INCOMPLETE VACCINATION HISTORIES
  • The vaccination histories were not always
    complete.
  • For children with 4 provider doses of DTaP, about
    31 of children had one or more doses missing in
    the registry data.
  • For children with 4 registry doses of DTaP, only
    about 9 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.

15
IMPLICATIONS FOR DATA QUALITY
  • MIXED PATTERN OF MISSING DATA
  • The frequency and order of the missing doses for
    DTaP varied by source of data.
  • Therefore, source of data should be considered
    when interpreting results and making estimates.
  • The fourth DTaP 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.

16
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

17
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.

18
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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