Central Jersey Family Health Consortium 2 King Arthur CT, 2 nd FLR Conference RM, N Brunswick, NJ June 27, 2012

Transcription

1 Central Jersey Family Health Consortium 2 King Arthur CT, 2 nd FLR Conference RM, N Brunswick, NJ June 27, 2012 AGENDA Welcome and Introductions Presentation: Using NJIIS for the Public Health Assessment of Community Age- Appropriate Immunization Rates, Peter Wenger, MD Education Workgroup Report Megan Avallone, RN and Leslie Leonard, RN Vaccine Hesitancy Program School Immunization Regulation Workgroup Report Jenish Sudhakaran, MPH and Marlene Dolan, RN Vaccine Hesitancy Learning Session Update Sandy VanSant, HO, RN

2 Central Jersey Family Health Consortium 2 King Arthur CT, 2 nd FLR Conference RM, N Brunswick, NJ June 27, 2012 NJIIS Report Simi Octania-Pole, PhD Registry Interfaces and Technology Larry Frenkel, MD NJDHSS Update Barbara Montana, MD Issues of Interest: National Adult Immunization Campaign Webinar Topics Presentation Topics for Fall Meetings Other Adjourn Next Meeting Dates: August 22, 2012 September 26, 2012 October 24, 2012 November 28, 2012

3 Using NJIIS for the Public Health Assessment of Community Age-Appropriate Immunization Rates New Jersey Immunization Network June 27, 2012

4 R KIDs Project CDC-funded project Department of Preventive Medicine and Community Health at UMDNJ- NJMS To increase timely ACIPrecommended immunization rates in pre-school children East Orange, Irvington, and Orange Method to evaluate immunization rates in these communities

5 R KIDs Project Expert Panel 2006 Automated telephone immunization reminder system Implementation in study communities- February 2007 Data collection and analysis Provider-based - 41 practices/5 hospital-based clinics Selected on basis of utilization of NJIIS for a minimum of 1 year as of 01/01/07 17 practices/3 hospital-based clinics 13/20 providers agreed to participate and signed informed consent NJIIS and healthcare provider office/clinic paper immunization records Two cohorts Pre-intervention: 01/01/05 12/31/05 Post-intervention: 01/01/07 12/31/07 IRB approved UMDNJ New Jersey DHSS

6 Audit Process Flow Diagram 2a 1 Initial Download of Immunization Records Of Eligible Subjects (by DOB and Family Residence) From NJIIS Immunizations are months on NJIIS at Pre-audit Download 2b Immunizations are Not 13 months on NJIIS at Pre-audit Download

7 Audit Process Flow Diagram 2b Immunizations are Not 13 months on NJIIS at Pre-audit Download Paper Medical Records (MRs) Sought at Practitioners Office 3a Paper MRs of Subjects Not Found In Practitioner s Office 3b Paper MRs of Subjects Found In Practitioner s Office

8 Audit Process Flow Diagram 3b Paper MRs of Subjects Found In Practitioner s Office 4a Found Paper MRs that Did not Require Updating in NJIIS (Immunization Record is complete In NJIIS but Immunization Status is Not UTD) 4b Found Paper MRs that Required Updating In NJIIS

9 Audit Process Flow Diagram 4b Found Paper MRs that Required Completion In NJIIS 5a Found Paper MRs that Required Completion in NJIIS where the Subject s Immunization Status is 13 months 5b Found Paper MRs that Required Completion in NJIIS where the Subject s Immunization Status is Not 13 months

10 Results

11 Number and Percentage of Records of the Study Population in Participating Provider Practices in NJIIS with Respect to Estimate of Total Cohort of Interest by City, Pre-Intervention Cohort Born: 1/1/05 12/31/05 Birth File ARs From NJIIS AR/BF (%) {95% CI] Records From NJIIS (AR-NF=NFE) NFE/BF (%) [95% CI] East Orange /1021 (22.2%) [19.8%, 24.9%] /1021 (20.8%) (18.4%, 23.4%) Irvington /1069 (30.6%) [27.9%, 33.4%] /1069 (28.5%) (25.9%, 31.3%) Orange /552 (20.7%) [17.5%, 24.2%] Totals /2642 (25.3%) [23.7%, 26.7%] /552 (19.9%) (16.8%, 23.5%) /2642 (23.7%) (22.2%, 25.4%) AR=All Records of study population assigned to participating providers in NJIIS BF= Birth File (provided by NJDHSS) NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic NFE= AR NF

12 Number and Percentage of Records of the Study Population in Participating Provider Practices in NJIIS with Respect to Estimate of Total Cohort of Interest by City, Post-Intervention Cohort Born: 1/1/07 12/31/07 Birth File All Records From NJIIS AR/BF (%) [95% CI] Records From NJIIS (AR-NF=NFE) NFE/BF (%) [95% CI] East Orange /1060 (19.2%) [16.9%, 21.6%] /1060 (18.3%) [16.1%, 20.1%] Irvington /1052 (27.5%) [24.9%, 30.3%] /1052 (26.3%) [23.8%, 29.1%] Orange /583 (20.2%) [17.2%, 23.7%] /583 (19.2%) [16.2%, 22.6%] Totals /2695 (22.6%) [21.1%, 24.3%] /2695 (21.6%) [20.1%, 23.2%] AR=All Records of study population assigned to participating providers in NJIIS BF= Birth File (provided by NJDHSS) NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic NFE= AR NF

13 Percentage of Records of the Study Population in Participating Provider Practices in NJIIS with Respect to Estimate of Total Cohort of Interest by City, Pre- and Post-Intervention Cohorts Pre-Intervention Cohort (01/01/05 12/31/05) All Records/Birth File 25.3% (95% CI; 23.7%, 26.7%) Not Found Excluded/Birth File 23.7% (95% CI; 22.2%, 25.4%) Post-Intervention Cohort (01/01/07 12/31/07) All Records/Birth File 22.6% (95% CI; 21.1%, 24.3%) Not Found Excluded/Birth File 21.6% (95% CI; 20.1%, 23.2%) AR=All Records of study population assigned to participating providers in NJIIS BF= Birth File (provided by NJDHSS) NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic NFE= AR NF

14 Immunization Status of Study 13 Months By City Pre-Intervention Cohort (Born: 01/01/05 12/31/05) East Orange AR Records Not Found (NF) AR-NF (NFE) UTD (%) [95% CI] /212 (89.6% ) [ 84.7%, 93.1%] NUTD (%) [95% CI)] 22/212 (10.4%) [6.9%, 15.3%] Irvington /305 (88.9%) [84.8%, 91.9%] 34/305 (11.2%) [8.1%, 15.2%] Orange /110 (90.9%) [83.9%, 95.2%] 10/110 (9.1%) [4.9%, 16.1%] Totals /627 (89.5%) [86.8%, 91.2%] 66/627 (10.5%) [8.4%, 13.2%] Up-to-Date (UTD) = refers to child s immunization status is complete as per ACIP recommendations Not-Up-to-Date (NUTD) = refers to child s immunization as in-complete as per ACIP recommendations AR=All Records of study population assigned to participating providers in NJIIS NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic

15 Immunization Status of Study 13 Months By City Post-Intervention Cohort (Born: 01/01/07 12/31/07) East Orange AR Records Not Found (NF) AR-NF UTD (%) [95% CI] /194 (77.8%) [71.5%, 83.1%] NUTD (%) (95% CI) 43/194 (22.2%) [16.9%, 28.6%] Irvington /277 (79.1%) [73.9%, 83.5%] 58/277 (20.9%) [16.6%, 26.1%] Orange /112 (75.0%) [66.2%, 82.1%] 28/112 (25.0%) [17.9%, 33.9%] Totals /583 (77.9% ) [74.3%, 81.2%] 129/583 (22.1%) [18.9%, 25.7%] Up-to-Date (UTD) = refers to child s immunization status is complete as per ACIP recommendations Not-Up-to-Date (NUTD) = refers to child s immunization as in-complete as per ACIP recommendations AR=All Records of study population assigned to participating providers in NJIIS NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic

16 Immunization Status of Study 13 Months Totals Pre-and Post-Intervention Cohort Pre-Intervention Cohort (1/01/05-12/31/05) Up-to-Date 561/627 (89.5%) [95% CI; 86.6%, 91.2%) Not Up-to-Date 66/627 (10.5%) [95% CI; 8.4%, 13.2%] Post-Intervention Cohort (1/01/07-12/31/07) Up-to-Date 454/583 (77.9%) [95% CI; 74.3%, 81.3%] Not Up-to-Date 129/583 (22.1%) [95% CI; 18.9%, 25.7%]

17 Sensitivity Analysis of Immunization 13 Months By City Pre-Intervention Cohort (Born: 01/01/05-12/31/05) East Orange UTD 190/212 (89.6%) Irvington 271/305 (88.9%) Orange 100/110 (90.9%) Totals 561/627 (89.5%) AR-NF (NFE) Records Not Found (NF) AR Sensitivity Analysis of UTD (Best Case Scenario) Sensitivity Analysis of UTD (Worst Case Scenario) /227 (90.3%) 190/227 (83.7%) /327 (89.6%) 271/327 (82.9%) /114 (91.2%) 100/114 (87.7%) /668 (90.1%) 561/668 (84.0%) AR=All Records of study population assigned to participating providers in NJIIS NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic

18 Sensitivity Analysis of Immunization 13 Months By City Post-Intervention Cohort (Born: 01/01/07-12/31/07) East Orange UTD 151/194 (77.8%) Irvington 219/277 (79.1%) Orange 84/112 (75.0%) Totals 454/583 (77.9%) AR-NF (NFE) Records Not Found (NF) AR Sensitivity Analysis of UTD (Best Case Scenario) Sensitivity Analysis of UTD (Worst Case Scenario) /203 (78.8%) 151/203 (74.4%) /289 (79.9%) 219/289 (75.8%) /118 (76.3%) 84/118 (71.2%) /610 (78.9%) 454/610 (74.4%) AR=All Records of study population assigned to participating providers in NJIIS NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic

19 Completeness of Records in NJIIS By City Pre-Intervention Cohort (Born 1/1/05 12/31/05) East Orange Complete in NJIIS Incomplete in NJIIS Records Not Found (NF) AR AR-NF (NFE) Complete in NJIIS (%) [95% CI] /212 (86.8%) [81.5%, 90.1%] Irvington /305 (81.3%) [76.5%, 85.3%] Orange /110 (96.3%) [90.1%, 98.9%] Totals /627 (85.8%) [82.3%, 88.3%] AR=All Records of study population assigned to participating providers in NJIIS NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic

20 Completeness of Records in NJIIS By City Post-Intervention Cohort (Born 1/1/07 12/31/07) Complete in NJIIS Incomplete in NJIIS Records Not Found (NF) AR AR-NF (NFE) Complete in NJIIS (%) [95% CI] East Orange /194 (83.5%) (77.6%, 88.1%) Irvington /277 (80.1%) (75.0%, 84.4%) Orange /112 (89.3%) (82.1%, 93.9%) Totals /583 (83.0%) (79.8%, 85.9%) AR=All Records of study population assigned to participating providers in NJIIS NF= Paper immunization records not found in NJIIS-assigned participating providers office/clinic

21 Completeness of Records in NJIIS Totals Pre- and Post-Intervention Cohort Pre-Intervention Cohort (01/01/05-12/31/05) 538/627 (85.8%) [95% CI; 82.3%, 88.3%] Post-Intervention Cohort (01/01/07-12/31/07) 484/583 (83.0%) [95% CI; 79.8%, 85.9%]

22 Number of Immunizations needed to bring subjects/patients UTD (Report generated by CoCasa) Cohort 1: Born 1/1/05 12/31/05 Cohort 2: Born 1/1/07 12/31/07 Of patients Not complete, # of patients who could be brought UTD with 1 additional visit: 49 of 66 Immunizations Needed # of Patien ts % of Patien ts 1 37/66 56% 2 12/66 18% 3 0 0% % Total Patients UTD with one additional visit 49/66 74% Of patients Not complete, # of patients who could be brought UTD with 1 additional visit: 84 of 129 Immunizations Needed # of Patient s % of Patien ts 1 59/129 46% 2 22/129 17% 3 2/129 2% 4+ 1/129 1% Total Patients UTD with one additional visit 84/129 65%

23 Community Assessment of Age-Appropriate Immunization Rates using the NJIIS Children, ages 19 through 35 months of age Newark, NJ 4 DTaP:3 poliovirus:1 MMR:3 Hib:3 HepB:1 varicella Immunization Program in the Newark Department of Child and Family Well-Being Janice Alford Physician and Childcare Center/Preschool Liaison and NJIIS Trainer Nisha Jani - City Epidemiologist Dorothy McCall Child Adolescent Healthcare Program Director (Immunization Program/Project Vaccinate) Edward Vallejo MPH student investigator (UMDNJ SPH)

24 Assessment Process Define cohorts by birthdate Evaluation date - 9/30/11 10/01/08 02/28/10 Evaluation date 9/30/10 10/01/07 02/28/09 Evaluation date 09/30/09 10/01/06 02/29/08

25 Assessment Process Request to NJIIS for data Registry ID # Birth date City of residence/zipcode Immunization data Antigen type Date of administration Insurance type/provider (not used in this analysis) Sent in an Excel spreadsheet Turnaround time 5 working days

26 Assessment Process Save Excel spreadsheet as a.csv file Preparation 1 week Upload.csv data to CoCASA Due to tremendous file size Process time 1 week Output Any single parameter minutes

27 Results In Search of a Denominator NJ Birth File vs NJIIS months Cohort 1 Cohort 2 Cohort 3 Birth Date Range 10/1/06-2/29/08 10/1/07-2/29/09 10/1/08-2/28/10 Assessment Date 9/30/09 9/30/10 9/30/11 NJ Birth File Data n =6859 n = 6762 n = 6622 NJIIS Data n = 7803 n = 7639 n = 7230

28 Results In Search of a Denominator NJ Birth File vs NJIIS months Cohort 1 Cohort 3 Birth Date Range 10/1/06-2/29/08 10/1/08-2/28/10 Assessment Date 9/30/09 9/30/11 NJ Birth File Data n =6859 n = 6622 NJIIS Data n = 7803 n = 7230

29 Results Immunization Rates by Antigen NJIIS, months, Newark, NJ Cohorts 1 and 3 Antigen(s) Cohort 1 N = 7803 n (%) Cohort 3 N = 7230 n (%) 4+DTaP 3364 (43%) 2759 (38%) 3+Poliovirus 4632 (59%) 3854 (53%) 1+MMR 5155 (66%) 4590 (64%) 3+Hib 5282 (68%) 4897 (68%)

30 Results Immunization Rates by Antigen NJIIS, months, Newark, NJ Cohorts 1 and 3 Antigen(s) Cohort 1 N = 7803 n (%) Cohort 3 N = 7230 n (%) 3+HepB 4588 (59%) 3781 (52%) 1+Varicella 5016 (64%) 4515 (62%) 3+PCV 4989 (64%) 4349 (60%) 4+PCV 4203 (54%) 3676 (51%)

31 Results Immunization Rates by Series NJIIS, months, Newark, NJ Cohorts 1 and 3 Antigen(s) Cohort 1 N = /30/2009 n (%) Cohort 3 N = /30/2011 n (%) 4: (42%) 2710 (37%) 4:3: (39%) 2546 (35%) 4:3:1: (38%) 2538 (35%) 4:3:1:3: (34%) 2262 (31%) 4:3:1:3:3: (32%) 2221 (31%) Not Complete 5278 (68%) 5009 (69%) 4+DTaP:3+poliovirus:1 MMR:3+Hib:3+HBV:1+varicella

32 Results Require 1 Visit to be Brought UTD NJIIS, months, Newark, NJ Cohorts 1 and 3 # of Immunizations Needed Cohort 1 N = 2506 (48%) 9/30/2009 n (%) Cohort 3 N = 2015 (40%) 9/30/2011 n (%) (51%) 933 (46%) (21%) 454 (23%) (18%) 443 (22%) (11%) 185 (9%) 4+DTaP:3+poliovirus:1 MMR:3+Hib:3+HBV:1+varicella

33 Results Potential UTD Immunization Rates, NJJIS, months, Newark, NJ Cohorts 1 and 3 Cohort 1 N = 7803 UTD + 1 visit/n % 9/30/ / % Cohort 3 N = 7230 UTD + 1 visit/n % 9/30/ / %

34 Conclusions Work in progress as public health assessment tool Methodology requires further development Denominator data determination Data cleansing Labor-intensive Access issues Local health departments Preschools, daycare centers, schools Incomplete participation and use by providers Underestimates timely, age-appropriate immunization rates When used, data appears close to complete December 31, 2011

35 Conclusions Appears 4 th dose of DTaP (and PCV though not counted in 4:3:1:3:3:1 series) most difficult to administer in a timely manner Significant # of children can be brought UTD in 1 visit

36 Preschool and Daycare Center Immunization Rate Audits Immunization Program, NDCFWB, Newark, NJ NJIIS audits NJ State Sanitary Code 8:57 Subchapter 4 Annual audits Quarterly or bi-annual audits? No manual audits by April /152 (49%) centers have received training

37 CENTRAL WARD CENTRAL WARD EAST WARD NORTH WARD SOUTH WARD SOUTH WARD SOUTH WARD WEST WARD WEST WARD # of Centers Enrollment CENTRAL WARD EAST WARD NORTH WARD SOUTH WARD WEST WARD TOTAL

38 Child Care Center Technology Survey Results as of 11/3/2011 Child Care Centers Contacted 152 Child Care Centers Responded 121 Response Rate 80% Question #1 - Do you have computers with internet access at your facility? Question #2 - What are these computers used for? Question #3 - What system do you currently use to document the immunization status of your children? Question #4 - How many employees are trained to upload information into NJIIS? (of the 26 centers that confirmed NJIIS use) Question #5 - Which of your employees are responsible for uploading information into NJIIS? (of the 26 centers that confirmed NJIIS use) n = 121 centers Internet Access 100% 121 Computer use type n = 121 centers Data entry / file archiving 100% 121 Teaching / Learning 78% 94 Documentatio n type n = 121 centers Yellow cards 100% 121 Yellow cards only 79% 95 NJIIS 21% 26 NJIIS only 0% 0 # of employees trained n = 26 centers 1 54% % % % 4 (approx 54 employees total among 26 ctrs) Type of worker n = 26 centers Family worker 62% 16 Nurse 23% 6 Administrative assistant 15% 4

39 Questions And Discussion