Point of Service vs. Real Time Registry-based Coverage Assessment - PowerPoint PPT Presentation

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Point of Service vs. Real Time Registry-based Coverage Assessment

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... University, New York, NY ... New York Presbyterian Hospital. Ambulatory Care Network. Community ... Regular downloads to NY Citywide Immunization Registry ... – PowerPoint PPT presentation

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Title: Point of Service vs. Real Time Registry-based Coverage Assessment


1
Point of Service vs. Real Time Registry-based
Coverage Assessment
  • M. Irigoyen, S. Findley, S. Chen,F. Chimkin, O.
    Peña
  • Northern Manhattan Immunization Partnership
  • Columbia University, New York, NY

2
Background
  • Immunization registries are expected to include
    all immunizations, but this may not be the case
  • Discrepancy in coverage rates assessed at
    different points in time may highlight problems
    in registry completeness

3
Objective
  • To compare registry-based coverage rates assessed
    at two points in time real time (assessment
    date) and last point of service (last visit)

4
Organizational Setting
  • Northern Manhattan Immunization Partnership
    (NMIP), NYC, a CDC funded demonstration project
  • NMIP developed a regional registry to facilitate
    sharing of records among practices and expedite
    upload to city immunization registry

5
Ez VAC Registry
EzVAC Registry
School Based Clinics
New York Presbyterian Hospital Ambulatory Care
Network
Community Providers
NYC DOH Citywide Immunization Registry
6
NMIP Immunization Registry
  • Private registry for Northern Manhattan
  • Web-based and real time
  • Regular downloads to NY Citywide Immunization
    Registry
  • Launched March 1999
  • Currently at 30 practices, 120,000 children
  • 98 vaccine capture rate

7
Study Population
  • Latino and low income children 6-23 months,
  • 5 hospital-affiliated practices in Northern
    Manhattan, NYC

8
Eligibility Criteria
  • born after registry rollout
  • ages 6-23 months at assessment
  • 1 visit to the practice
  • age of last visit gt3 months
  • 1 immunizations in registry

9
Assessment Methods Compared
  • Coverage rates at two points in time
  • an assessment date (10/01/01 and 04/01/02
  • the last point of service (visit) prior to the
    assessment date
  • n 4,725

10
Last Point of Service (last visit) vs. Date of
Assessment (four examples)
Assessment Date (04-01-02)
11
Outcomes
  • DTaPPolioMMRHibHepB (43133)
    age-appropriate immunization coverage rates at
    assessment date and at last point of service
    (last visit)

12
Comparison of Coverage Rates (6-11 months Old)


p lt .01 p lt .001
13
Comparison of Coverage Rates (12-23 months Old)


p lt .001
14
Conclusion
  • The difference may be due to record scatter or
    disengagement from care.
  • Regular sharing of records between registries is
    needed to ensure accurate immunization
    assessments.
  • Registry generated reminder/recall can help
    decrease disengagement and narrow the gap between
    estimates.

15
Implications
  • Registry-based assessments at an assessment date
    and at last point of service (last visit) offer
    complementary perspectives on vaccine delivery
    and documentation that can guide registry quality
    improvement
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