KEYWORDS:
data quality, immunization records, anthrax vaccine, military
BACKGROUND:
The Department of Defense has been charged with evaluating birth outcomes among infants born to military women who received anthrax immunization. Electronic data from the US Military Immunization Database were used to identify exposures. Because the timing of anthrax immunization in relation to conception and pregnancy is critical to analysis, validation of information in the military database has been required.
OBJECTIVE:
To evaluate the quality of anthrax immunization information in the Military Immunization Database.
METHOD:
Original medical records of childbearing women serving in the military between 1998 and 2000 were identified at the records archive center in St. Louis. A team of professional abstractors reviewed all immunization entries. These data were compared to information in the electronic database, and measures of agreement were assessed.
RESULT:
Among 11,271 medical records reviewed, 1318 (11.7%) contained anthrax immunization data. A comparison between medical record and electronic data revealed that the database under-recorded immunization in 38.5% of those actually immunized, and over-recorded immunization in 2.5% of apparently non-immunized women. Overall accuracy of the data was
93.3%. Measures of agreement were stronger in Marine Corps and Air Force data than other services. Among immunization doses found in both the database and medical records, there was strong agreement on the dates of immunization.
CONCLUSION:
The Military Immunization Database identifies critical preparedness for infectious disease threats, including bioterrorism. The database is also a valuable epidemiological resource for addressing health concerns related to immunizations. These validation analyses, performed as part of a study on birth outcomes after anthrax immunization, reveal that database information is accurate. Under-recording of immunizations is a greater challenge than mis-recording.
LEARNING OBJECTIVES:
To understand the type and quality of data maintained in the Military Immunization Database, based on a large validation analysis of records from military women.
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