Monday, October 27, 2003
3677

This presentation is part of : Poster Presentations

Identification and Recall of Children with Chronic Medical Conditions for Influenza Vaccination

Matthew F Daley1, Jennifer Barrow2, Kellyn Pearson3, Lori A Crane4, John Stevenson5, Stephen Berman1, and Allison Kempe1. (1) Department of Pediatrics & the Children's Outcomes Research Program, University of Colorado Health Sciences Center, 1056 E. 19th Avenue, B032, Denver, CO, USA, (2) Children's Outcomes Research Program, University of Colorado Health Sciences Center, P.O. Box 6508/F456, Aurora, CO, USA, (3) Children's Outcome Research Program, University of Colorado Health Sciences Center, Colorado Immunization Information System, PO Box 6508/F456, Aurora, CO, USA, (4) Preventative Medicine & Biometrics, University of Colorado Health Sciences Center, 4200 E 9th Ave, Box C-=245, Denver, CO, USA, (5) NIP/ISD/HSREB, CDC, 1600 Clifton Road, NE, MS E-52, Atlanta, GA, USA


KEYWORDS:
Influenza Vaccination, Chronic Medical Conditions, Billing Data, Reminder/Recall, Immunization Registries

BACKGROUND:
Despite recommendations to provide influenza vaccination to children with chronic medical conditions, only 7-10% are immunized yearly.

OBJECTIVE:
1) to determine the prevalence of influenza-related high-risk conditions (HRCs) in 4 pediatric private practices; 2) to assess the accuracy of billing data for identifying children with HRCs; and 3) to evaluate the efficacy of reminder/recall for children with HRCs.

METHOD:
We linked registry records with the billing database for all children age 6-72 mos for four pediatric practices in metropolitan Denver, Colorado. Children with HRCs were identified using ICD-9-CM diagnostic codes. Patients with 1 or more encounters for an HRC in the prior 24 months were designated as having an HRC. To determine the sensitivity, specificity, and accuracy of billing data for identifying HRCs we reviewed 327 randomly selected medical records. For HRC subjects, we conducted a randomized controlled trial of reminder/recall for influenza vaccination, with the intervention group receiving up to 2 letters and 1 postcard.

RESULT:
Of the 17,273 subjects age 6-72 months, 2,007 had 1 or more HRC (12% overall, range 9% to 14% per practice), based on a set of > 150 ICD-9-CM codes. Billing data had a sensitivity of 67% (95% CI: 55%-79%), specificity of 95% (CI: 93%-97%), and overall accuracy of 91% (CI: 88%-94%) in determining which children had a HRC. Reminder/recall significantly increased the influenza immunization rate in the intervention group compared to those not recalled (41% vs. 25%, p<0.001).

CONCLUSION:
Diagnosis-based billing data provided a feasible and accurate means of identifying children with HRCs. Linking billing data to an immunization registry created an efficient and effective mechanism for reminder/recall, which significantly increased influenza immunization in children with a HRC.

LEARNING OBJECTIVES:
Learner will be able to describe the effect of a flu recall for children with a high risk condition.

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