Regional Early Childhood Immunization Network (RECIN)

Producing and Measuring Quality Outcomes for At-Risk Children

Tina Ellis CoyleMarshfield ClinicMarshfield, WI

October 28, 2005 Copyright @ 2005 Marshfield Clinic 2

Why Do We Need Registries?

Immunizations may have been the #1 public health advancement in the 20th Century, however...

Barriers to children being properly immunized include

– complex immunization schedule– fragmentation of care– Calls from provider to provider are time consuming

and costly

October 28, 2005 Copyright @ 2005 Marshfield Clinic 3

Requirements of a Successful Registry

Centralized repository accessible to both public and private immunization providers

Provide one common immunization record for each patient

Collect and retain all data required for giving an immunization

Assess and intervene on patients who are not immunization current

October 28, 2005 Copyright @ 2005 Marshfield Clinic 4

RECIN Background Web based, real-time registry Developed in the private sector, Marshfield Clinic Development team collaboration of private and public

providers Electronic recording and tracking network that all

immunization providers could use to record and assess immunization status of shared patients

Captures immunizations across the lifespan First deployed in 1995

October 28, 2005 Copyright @ 2005 Marshfield Clinic 5

Mission

The mission of RECIN is to provide a shared population based immunization recording,

tracking and intervention repository that assists communities in raising childhood and

adult immunization rates.

October 28, 2005 Copyright @ 2005 Marshfield Clinic 7

Intervention: It Takes a Collaborative Spirit

• Crosses competitive barriers

• Promotes a common vision by encouraging unique community-wide partnerships

• Outreach to under-immunized children

Public/private collaboration designed to raise immunization rates

October 28, 2005 Copyright @ 2005 Marshfield Clinic 8

Wood County Intervention

75,555 total population (2000 U.S. Census Bureau)

100% provider participation

0-2 year old population

December 1999 67% UTD

February 2001 93% UTD

October 2005 92% UTD

Objective: Raise immunization rates of 0-2 year olds to 95% UTD

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Wood County 2 year old immunization rate

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

12/3/1999 1/11/2000 2/10/2000 3/7/2000 4/17/2000 5/5/2000

5/23/2000 6/13/2000 7/5/2000 8/14/2000 10/9/2000 10/25/2000

11/20/2000 1/19/2001 2/1/2001 3/28/2001 4/13/2001 4/24/2001

October 28, 2005 Copyright @ 2005 Marshfield Clinic 10

Tiered Intervention Background

2001 task force of public/private providers met with a goal to develop countywide campaigns to raise immunization rates

Identified barriers to immunizations and developed methods to overcome them

Through RECIN, they developed an intervention process

October 28, 2005 Copyright @ 2005 Marshfield Clinic 11

Tiered Intervention

Comprehensive reminder system involving all providers in a demographic area collaborating to raise immunization rates

Allows providers to track and document individual patient’s intervention history

Moves patients through an automated intervention process

Prevents duplication of notices/contacts Automatic transition of non-compliant patients to Health

Departments if desired

October 28, 2005 Copyright @ 2005 Marshfield Clinic 12

Tiered Intervention Method Determine which immunizations and population to target Set Goal Assess population Proactive vs. Overdue Tiered vs. non-tiered approach Identify age group to target Set geographic parameters Customize letters to fit individual practices Begin intervention

October 28, 2005 Copyright @ 2005 Marshfield Clinic 13

Marathon County Intervention

125,834 total population (2000 U.S. Census Bureau)

12 immunization facilities in Marathon County– 100% participation

0-2 year old populationMay 2001 – 81% UTDMay 2002 reached 93% UTDNovember 2005 – 90% UTD

Marathon County0-2 Year Old Immunization Rates

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

5/30/2001 6/22/2001 7/13/2001 8/17/2001 9/12/2001 10/12/200111/16/2001 11/30/2001 12/14/2001 1/21/2002 2/5/2002 2/26/20023/15/2002 4/9/2002 5/13/02

October 28, 2005 Copyright @ 2005 Marshfield Clinic 15

Marshfield Clinic FHC Results (patients 24-35 Months UTD)

Communicate Results: Utilization of balanced scorecardCenter 2001 2005Phillips 74.1 93.8Cadott 66.7 100Colby/Abby 84.9 100Athens 33.3 100Chippewa Falls 88.0 94.2Marshfield Clinic85.7 91.1

October 28, 2005 Copyright @ 2005 Marshfield Clinic 16

Improving the Quality of Health Care: Lessons Learned

You need to first start You need the right tool:

– Increase provider participation – Facilitate community wide intervention efforts

Set a goal and communicate performance measures Take what we’ve learned and expand to other regions You need champions

Goal: Protect patients from immunization preventable disease

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Promotes Community Partnerships Wisconsin Department of

Health and Human Services Local Health Departments Private Providers Schools Daycare Facilities Retirement Communities Service Organizations Parents/Patients

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State and National Recognition

2001 Paul Harris Rotary Award2002 National Immunization Registry Protect

Award– Presented on behalf of the American Academy of

Pediatrics and the National Immunization Program of the CDC

2002 Legislative Citation

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In Summary

The IOM Quality Chasm report says:

“The current care systems cannot do the job.” “Trying harder will not work.” “Changing care systems will.”