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Identifying children with chronic conditions for influenza vaccination using a statewide immunization registry:
Sarah J Clark1, Kara Lamarand, Kevin J Dombkowski
1Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI, USA. saclark@umich.edu
Insights
Most primary care providers did not recall seeing the Michigan Care Improvement Registry (MCIR) high-risk indicator for influenza vaccination. Enhancements are needed to improve its usefulness in identifying at-risk children.
Area of Science:
- Public Health
- Immunization Registries
- Pediatrics
Background:
- Children with chronic medical conditions face higher risks from influenza but have low vaccination rates.
- The Michigan Care Improvement Registry (MCIR) implemented a high-risk indicator in 2006 to prompt influenza vaccination for high-risk children using Medicaid claims.
Purpose of the Study:
- To evaluate primary care providers' experiences with the MCIR high-risk indicator for influenza vaccination.
- To gather suggestions for improving the indicator's effectiveness.
Main Methods:
- A cross-sectional survey was administered to 600 primary care providers (300 pediatricians, 300 family physicians) in Michigan in July 2009.
- The survey assessed provider recall and perceived helpfulness of the MCIR high-risk indicator and requested improvement suggestions.
Main Results:
- A 79% response rate was achieved.
- Only 32% of pediatricians and 17% of family physicians recalled seeing the indicator during the 2008-2009 influenza season.
- Of those who saw it, 48% found the indicator helpful; 77% desired it to cover all children, not just Medicaid enrollees, and 71% wanted a practice-level list of high-risk children.
Conclusions:
- Three years post-implementation, the MCIR high-risk indicator was not widely recognized by providers.
- While half of users found it helpful, most providers supported expanding its scope to improve identification of children needing influenza vaccination.
- Further research should investigate how enhanced registry capabilities can better assist providers in identifying priority cases for vaccination.
Context:
Children with chronic medical conditions are at increased risk of complications from influenza, yet their vaccination rates are low. The Michigan Care Improvement Registry (MCIR), a statewide immunization registry, was expanded in 2006 to include an indicator, based on Medicaid administrative claims, that prompts providers to offer influenza vaccine to high-risk children (ie, those with chronic conditions).
Objective:
To assess primary care providers' experiences with the MCIR high-risk indicator.
Design:
A cross-sectional, self-administered survey mailed in July 2009.
Setting:
State of Michigan.
Participants:
A total of 300 family physicians and 300 pediatricians who served as primary care providers for children in Michigan's Medicaid program.
Main Outcome Measures:
Provider experiences with the high-risk indicator; suggestions for improvement.
Results:
Response rate was 79%. Only 32% of pediatricians and 17% of family physicians recalled seeing the high-risk indicator during the 2008-2009 influenza season. Of those who saw the indicator, 48% rated it as "helpful" or "very helpful" in identifying which children should receive flu vaccine. To improve its usefulness, 77% of respondents wanted the indicator to reflect all children, rather than only those enrolled in Medicaid, and 71% wanted MCIR to generate a list of high-risk children in their practice.
Conclusions:
Three years after implementation, the registry-based high-risk indicator is not viewed by most providers. Half of those who saw the indicator found it helpful, and most respondents endorsed enhancements to broaden its scope. Future work should explore whether enhanced capabilities help to facilitate identification of priority cases by providers.
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