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Background: Flu vaccination rates among high-risk children remain low, despite longstanding recommendations; prior research has demonstrated that providers often overlook flu vaccination for high-risk children. To address this problem, Michigan unveiled a “high-risk indicator” to identify children with chronic conditions, based on Medicaid/Title V administrative data; when a high-risk child’s record is accessed in the Michigan Care Improvement Registry (MCIR) during flu season, a pop-up screen prompts providers to evaluate for flu vaccination eligibility
Objectives: To elicit Michigan primary care providers’ perspectives on the high-risk indicator.
Methods: Mail survey of 600 Michigan Medicaid primary care providers, with16 fixed-choice items.
Results: Response rate was 79%. Among the 95% of respondents who currently use MCIR, 91% usually have patients’ MCIR immunization information prior to or during well-child visits, while 53% usually have such information for sick visits. One fourth recalled seeing the high-risk indicator during the 2008-09 flu season; of these 41% rated it VERY HELPFUL and 23% HELPFUL in identifying which children should receive flu vaccine. Providers who did not see the indicator viewed it less favorably. Main reasons for non-use were: able to identify high-risk patients myself (45%); not needed because all children should receive flu vaccine (33%); and data accuracy concerns (29%). Suggested improvements were: create lists of high-risk children for each practice (78%), assist with generating reminder notices (63%), and include privately-insured children (51%).
Conclusions: Providers who saw the high-risk indicator found it helpful in identifying high-risk children. To expand use of the indicator, immunization officials should provide feedback on practice-level flu vaccination rates for high-risk children, and develop user-friendly mechanisms for generating rosters and reminder notices for high-risk children.