Learning Objectives for this Presentation:
By the end of this presentation, participants will be able to describe differences in immunization coverage by provider type for Arizona AI/AN children.

Background:
In Arizona 6.5% of 19-35 month old children are AI/AN.

Setting:
During 2005, the Arizona State Immunization Information System (ASIIS) began sharing data with 14 of 19 Indian Health Service (IHS) and tribal service units.

Population:
There are 9011 children 19 to 35 months of age in ASIIS who can be identified as AI/AN based on provider-submitted AI/AN indicator, parental report of AI/AN race/ethnicity from birth records or immunization service from an IHS/tribal provider. This compares well with a 2006 census projection of 9572 children.

Project Description:
Immunization providers were classified as: IHS/tribal, non-IHS public, and private practice. ASIIS records were compared with the 4:3:1:3:3 immunization schedule. Calculated coverage rates were compared with type of site(s) from which services had been received. Excess DTaP, IPV and Hib shots were also counted as a measure of extraimmunization.

Results/Lessons Learned:
Within ASIIS, 4188 AI/AN patients who saw only one IHS/tribal provider demonstrated a 4:3:1:3:3 completion rate of 72%. The 325 patients seeing only one non-IHS public provider showed coverage rates of 54%. The 801 patients seeing only one private provider had coverage rate of 26%.
When children saw more than one IHS provider, their coverage rates improved from 72% to 82%. However, their extraimmunization rates also went up, from 4% to 18%. Over all types, when children saw multiple providers their coverage rates did not improve, 64% (one) and 66% (multiple), and extraimmunization worsened from 5% to 17%.
We observe significantly better (p < 0.001) immunization coverage for AI/AN children visiting only IHS/tribal service units. We observe significantly less (p < 0.001) extraimmunization when only one provider is seen.