Using Immunization Registry-Generated Data and Best Practices to Improve Vaccination Rates of Underserved Children

Background:
Because registries compile information from multiple providers, they may assist healthcare practices in improving immunization rates especially among impoverished children at risk of under-immunization due to lack of a medical home or sporadic use of primary care preventative services.

Objectives:
Our goal was to increase immunization rates using registry-generated information at six pediatric health centers in Children's National Medical Center's Goldberg Center for Community Pediatric Health (GCCPH), the largest healthcare provider of pediatric services in the District of Columbia (DC) serving a 90% Medicaid enrollee population.

Methods:
From 2006 to 2008, GCCPH used DC Immunization Registry data to determine which children ages 0 to 35 months were due or overdue for vaccines according to the recommendations of the Advisory Committee on Immunization Practices. GCCPH partnered with the DC Immunization Program to allow direct entry of information into the registry, and improve bi-directional communication. Concurrently, GCCPH implemented patient and provider reminders, patient recalls and educational programs, and improved patient access through vaccinating at unscheduled visits.

Results:
Vaccination coverage rates for the 4:3:1:3:3:1 series increased from a pre-intervention rate of 75% (third quartile nationwide as compared with National Immunization Survey (NIS) data) in 2006 to 88% (top 5%) in 2008 for children ages 19-35 months. During this same period, the NIS series-specific ranking for DC improved from #27 to #6.

Conclusions:
Individual providers and practices can use registry-generated information to implement successful vaccination quality improvement activities targeting low-income populations that are less likely to receive regular preventative care. Specifically, registries can: 1) alert providers of the vaccines due at each visit; and 2) prompt practices to send patient reminders and recalls. Gaining permission to enter immunization data directly into the registry improves efficiency, and establishing regular communication with registry administrators reduces documentation errors that can spuriously reduce immunization compliance rates.