KEYWORDS:
Immunization registries

BACKGROUND:
A population-based county-wide immunization registry in operation since 1993 consolidates vaccine records from over 90% of public and private vaccine providers using either of three different methods--“sticker” sheets, electronic billing data or PC-based tracking software. The registry is used to provide outreach to families of apparently late toddlers.

OBJECTIVE(S):
To conduct an audit of registry immunization records by comparing them with primary care practice vaccination records. To measure completeness and accuracy of each reporting method, to identify sources of error in reporting, and to design a simple feedback report to assist practices in improving quality of reporting.

METHOD(S):
Comparisons of registry and chart vaccination records were conducted on random samples of 0-35 month old active patients in each of 12 private practices.

RESULT(S):
A total of 6668 charted vaccines and 600 children’s vaccination records from 12 different practices were included in the audit. While virtually all selected charts had a corresponding record in the registry, registry accuracy for practice samples ranged from 59% to 100%. Four of twelve practices had accuracies above 95%, three using billing data and one, a paper-based reporting system. Electronic billing records reporting was most accurate of the three methods. Billing data was compromised by vaccines given but not billed for (0-8% of charted vaccines) and historical vaccines not reported (0-12% of charted vaccines). Conversely, 0.4% of vaccines billed for were not recorded in the chart vaccine record. Both the PC software and sticker methods were compromised by incomplete reporting (11% and 23% of charted vaccines, respectively).

CONCLUSIONS(S):
Registry reporting using billing records was more accurate than paper-based methods of reporting, but was compromised by incomplete reporting of vaccines administered and of historical data.

LEARNING OBJECTIVES:
To demonstrate an approach to auditing a community registry and providing practice feedback on reporting accuracy.