Utility of a Regional Immunization Registry in a Pediatric Emergency Department

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Utility of a Regional Immunization Registry in a
Pediatric Emergency Department

• Collaboration between
• SUNY Upstate Medical University, Onondaga County
  Health Department and CNY Immunization Registry

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Authors

• CNY Immunization Registry
• Katie Reed, MPA
• SUNY Upstate Medical University
• Jim Callahan, MD, FAAP, FACEP
• David Reed, MD, FACEP
• Victoria Meguid, MD, FAAP
• Susan Wojcik, MS
• Onondaga County Health Department
• Cynthia OConnor, MPA

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Medical Students Participating

• SUNY Upstate Medical University
• Michael Danca
• Shari Goldfarb
• Toni Torrillo
• Amit Kumar

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For Patients treated in a Pediatric Emergency
Department

• 1. Can a registry be accessed during real-time
  ED care to determine immunization status?
• A. Prevalence of registry patients in the ED?
• B. Immunization status per registry?
• C. Rate of parental agreement with registry?

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Healthy People 2010

• Population-based immunization registries will be
  a cornerstone of the nations immunization system
  by the year 2010
• Link health care providers with immunization
  partners such as HMO, WIC, etc
• 95 of all children under the age of six will be
  in an immunization registry.

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Prior Investigations

• Randomized Study of Tracking with Outreach and
  Provider Prompting to Improved Immunization
  Coverage and Primary Care. Rodewald LE, et. al.,
  University of Rochester, New York, in Pediatrics,
  Jan 1999
• Providing Immunizations in a Pediatric Emergency
  Department Under-immunization Rates and Parental
  Acceptance. Cunningham SJ, Jacobi Medical Center,
  Bronx, in Pediatric Emergency Care, August 1999

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CNY Immunization Registry

• Regional registry, part of NYSIIS
• Population-based 14 county region
• Data collection began in 1998
• Voluntary physician participation
• Signed consent required

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Number of Children Consented Regionally
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14 County Saturation
NYSDOH July, 2001
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Primary Target Area Saturation
NYSDOH July 2001
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Study Setting

• CNY population 1.5 million
• Syracuse MSA 735,000
• Regional University Pediatric Emergency
  Department (17,530 visits)
• Designated tertiary pediatric ED (54 of all peds
  ED visits to Syracuse Hospitals)

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Methods

• Approved by IRB
• Study Design Prospective, observational, cohort
  study of ED patients 10 and younger
• Study Period 7 weeks of summer 2001
• Convenience sample 10A-MN (95 of volume)
• Interviews performed by medical students

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Registry Access

• Study site affiliated with University Pediatric
  and Adolescent Center
• Facilitated access from pediatric internal
  database with regional database, due to lack of
  modem access
• Trained medical student to query and print
  immunization history report using HealthyShot,
  registry software

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Results
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Results
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Individual Immunization Deficiencies
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Conclusions

• Real-time access was possible in an ED
• 34 of the children were in CNYIR
• 39 were documented to have immunization
  deficiencies
• Only 26 were aware of IR enrollment
• ED-PCP or outreach communication after an ED
  visit may improve identification of
  under-immunized patients

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Next Steps

• Continue to work on efforts to encourage data
  quality reviews at the providers sites.
• Continue public awareness campaign to
  parents/guardians about IR
• Establish mechanism for follow up to kids
  indicating immunization deficiencies.

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Contact Information

• Katie Reed
• Director, Public Health
• Partners In Health Systems
• PO Box 249
• 5703 Enterprise Parkway
• Dewitt, NY 13214
• 315-446-1612 ext 7217
• kreed_at_phs-us.com