Using An IIS to Assess Immunization Coverage: The New York City Experience

Background:
CDC considers Immunization Information Systems (IISs) to be useful tools for assessing immunization coverage. Three units of the Bureau of Immunization (BOI) of the New York City (NYC) Department of Health and Mental Hygiene have been using its IIS, the Citywide Immunization Registry (CIR), for this purpose.

Setting:
Child and adolescent immunization sites within NYC.

Population:
In 1997, NYC implemented a mandatory population-based childhood registry. It currently requires all healthcare providers to report to the CIR all vaccinations administered from birth through age 18 years. Approximately 85% of vaccines administered to NYC children are reported.

Project Description:
The three units using CIR data to assess coverage are: 1) Provider Quality Assurance, which supplements chart-based AFIX evaluations with CIR-based AFIX evaluations; 2) Immunization Improvement Spread Project (IISP), which conducts site visits and sends focused CIR-based reports to providers, reviewing coverage and offering suggestions to improve rates; and 3) CIR, which sends “Provider Report Cards” that include each facility's CIR up-to-date (UTD) rate and other immunization-focused information.

Results/Lessons Learned:
Data as of September 2008 demonstrate that: 1) The yearly number of AFIX assessments conducted has increased from 194 (when no assessments were conducted via CIR) for the twelve months ending September 2006, to 295 for the year ending September 2007, to 434 for the year ending September 2008. Overall, this represents a 124% increase in assessments; and 2) For the 134 facilities participating in IISP for at least one year, aggregate UTD rates increased from 33% to 48% UTD (a 45% improvement) among successive 24-35 month-old cohorts; and 3) The CIR has enabled over 1700 sites to receive quarterly facility-based coverage reports. Lessons learned from assessments of the 24-35 month-old populations have been extended to the 7-9 month-old populations by the IISP and CIR Units, and adolescent populations by the PQA unit.