KEYWORDS:
Practice coverage assessments, CASA, Registry

BACKGROUND:
Chart audits are the standard methodology for practice coverage assessment. Immunization registries now offer the potential for reliable and timely assessments.

OBJECTIVE(S):
To compare the use of chart audits and an immunization registry to assess practice coverage in a clinic network.

METHOD(S):
From 1996-2001, we conducted semi-annual assessments at a network of 5 inner-city practices in New York City. In 2000, we launched a private immunization registry at the network and, in 2001, we started using the registry to generate practice assessments.

RESULT(S):
To conduct chart audits we recruited and trained staff on CASA methodology, obtained clinic enrollment listings, generated a random sample of 300/clinic, extracted data from charts into scannable forms, entered, cleaned and verified data (partly automated), analyzed data, and generated reports that required a one-time programming and template creation. The labor associated with these tasks was estimated at 1030 hours for the 5 clinics, per semiannual cycle. For the registry assessment we were able to use the entire patient population. The registry already had automated built-in data cleaning and verification. The statistical analysis and generation of reports were the same as for chart audits. These tasks required 8 hours for the 5 clinics per semiannual cycle. In April 2001, the chart audits and the registry produced similar CASA coverage rates for children <12 months and an 11% rate difference for 12-23 month-olds. The major challenges to registry assessments were implementation costs and availability of historical data. The major benefits included the ability to run real-time assessments on the entire population at a relatively low cost.

CONCLUSIONS(S):
Immunization registries offer the potential for reliable, timely and low-cost practice coverage assessments.

LEARNING OBJECTIVES:
Compare the processes of using chart audits or registries to generate CASA reports.