Tuesday, March 18, 2008

Immunize Kansas Kids Phase 3: Comparison of Private and Public Immunization Rates

Sarah J. Clark1, John Rule2, Adrienne Nickles1, Shiming Dong1, and Gianfranco Pezzino2. (1) Child Health Evaluation and Research, University of Michigan, University of Michigan, 300 North Ingalls room 6E06, Ann Arbor, MI, MI, USA, (2) Public Health Studies, Kansas Health Institute, 212 SW 8th Ave, Suite 300, Topeka, KS, USA

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to compare private-sector and public-sector immunization patterns in Kansas.

Immunization rates for Kansas children have often been lower than the national average. One hypothesis is that referral of children who receive well-child care in private clinics to public health departments for immunizations has a negative effect on timeliness of immunization delivery.

Private and public clinics across Kansas.

Kansas children born between 2/1/04 and 6/1/05.

Project Description:
We first identified two groups of private-sector clinics: (A) those that provide childhood immunizations, and (B) those that provide well-child care but no immunizations. For those two groups, we categorized clinics into small, medium, and large size, based on the number of providers. We then designed a stratified sampling plan for the collection of children's immunization history, in order to generate statewide estimates of immunization rates for children who did vs did not receive immunizations in their private-sector medical homes. We compared up-to-date rates at 3, 7, 13, 19 and 24 months of age. Planned data collection data on dates of private-sector well-child visits, in order to measure the time to public-sector immunization, was suspended, due to private provider concerns about sharing visit data.

Results/Lessons Learned:
Up-to-date rates varied substantially by clinic and by age, indicating that even children who are up-to-date at 2 years of age may not receive immunizations at the recommended ages. Comparisons between private and public immunization settings also varied, suggesting that in some circumstances, the benefit of immunizing in the medical home may be outweighed by the benefit of immunization from public-sector immunization “experts.” We learned valuable lessons about willingness of providers to participate in this type of statewide initiative.