Matthew F. Daley1, Jennifer Barrow
2, Kellyn Pearson
2, Lori Crane
3, John M. Stevenson
4, Stephen Berman
5, and Allison Kempe
5. (1) Department of Pediatrics & the Children's Outcomes Research Program, Children's Outcomes Research Program, The Children's Hospital, 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) Department of Preventive Medicine and Biometrics, University of Colorado HSC, 4200 E. 9th Avenue, C245, Denver, CO, USA, (4) Centers for Disease Control and Prevention, National Immunization Program, 1600 Clifton Road, NE, MS E-52, Atlanta, Georgia, USA, (5) Department of Pediatrics & the Children's Outcomes Research Program, University of Colorado Health Sciences Center, 1056 E. 19th Avenue, B032, Denver, CO, USA
KEYWORD1:
influenza vaccination, immunization registries, billing data
BACKGROUND:
Despite long-standing recommendations to provide annual influenza vaccination to children with certain chronic medical conditions, only 7-10% are immunized yearly. While many barriers contribute to this public health failure, the lack of a systematic means of identifying targeted children presents a major obstacle.
OBJECTIVE:
1) to develop a set of ICD-9 codes of high-risk conditions (HRCs) for which influenza vaccination is recommended; and 2) to determine the prevalence of HRCs in young children in 5 large pediatric practices.
METHOD:
Five pediatric practices in metropolitan Denver, Colorado share a computerized billing system and also participate in an immunization registry, with the registry containing records for all patients < 72 mos. old. Initially we linked registry records for all children age 6-72 mos. with the billing database. The ICD-9 codes for HRCs were developed based on CDC/ACIP recommendations, with additional input from practice providers. Subjects with 1 or more encounter billed in the prior 18 mos. who had a visit for an HRC were designated as having an HRC.
RESULT:
Of the 20,236 subjects age 6-72 months, 2,494 (12.3%) had 1 or more HRC, based on a set of >150 different ICD-9 codes. The percentage of children with HRCs ranged from 8.6 to 14.4% per practice. Among children with an HRC the three most common conditions were asthma/reactive airways disease (n=2,259, 90.6%), bronchopulmonary dysplasia (n=57, 2.3%), and congenital heart disease (n=57, 2.3%).
CONCLUSION:
In 5 urban pediatric practices, ICD-9-based billing data identified 12.3% of young children as having a high-risk condition for influenza vaccination. This process, when linked to proven immunization delivery systems such as reminder/recall, provides the foundation for interventions to boost the chronically low immunization rate in children with targeted medical conditions. Two subsequent investigations are planned: a medical record review to determine the accuracy of the billing-based HRC designation, and a randomized controlled trial of registry-based reminder/recall for influenza vaccination.
LEARNINGOBJECTIVES:
1) to recognize the utility of billing data in identifying children needing annual influenza immunization; and 2) to understand that linkages between immunization registries and billing databases may help boost influenza rates in high-risk children.
See more of Influenza Vaccination Among Children
See more of The 37th National Immunization Conference
