Improving Immunization Coverage among Adolescents through Data Exchange and Recall

Background:
For the past 5 years, NYC Department of Health and Mental Hygiene's office of Health Care Access and the Citywide Immunization Registry (CIR) have been collaborating with Medicaid Managed Care Organizations (MMCOs) to raise immunization coverage among 9-36 month-old MMCO member children. With the recent introduction and recommendation of several vaccines for adolescents, this project was expanded to members 12-18 years of age in 2008.

Objectives:
To improve immunization coverage among adolescent members of MMCOs by providing CIR data to MMCOs, and identify adolescents missing immunizations.

Methods:
MMCOs were asked to submit demographic information for their Medicaid and Child Health Plus (CHP) members 12-18 years of age. These records were matched against the CIR and immunizations were extracted. Information returned to the MMCOs included: a) A file containing all patients found with their immunizations, and immunizations due for all recommended childhood and adolescent series (DTP, Tdap, Polio, MMR, Varicella, Meningococcal, HPV) together with percentage coverage and b) a “report card” with summary statistics for 13 year-olds only, indicating coverage for the “adolescent vaccine series”: 1Td/Tdap, 1 MCV4/MPSV (1:1) and 1:1 plus HPV for females (1:1:1 and 1:1:3).

Results:
15 MMCOs submitted 574,118 records (69% Medicaid and 31% CHP) of which 425,907 (74%) were found in the CIR with at least one immunization. Of those, 4.2% were up-to-date for all childhood and adolescent immunizations. Of the 65,694 13 year-olds found, 37,214 (56.6%) had 1Td/Tdap but only 19,548 (29.8%) had 1Td/Tdap and 1 MCV4. Only 21.2% of 13-year old females were complete for 1:1:1, and 6.6% for 1:1:3.

Conclusions:
Tdap coverage was high because of school requirement for 6th and 7th grade entrance. MCV4 and HPV coverage were substantially lower as was coverage for childhood immunizations, indicating a missed opportunity to administer all adolescent vaccines and to catch up on missing (or unreported) childhood immunizations.