Strategies to Leverage IIS Capabilities to Improve Outreach to Children with Chronic Conditions

Background:  Children with chronic conditions have increased risk of complications from influenza (flu) and historically have had low seasonal flu vaccination rates.  Opportunities exist to enable immunization information systems to target children with high-risk conditions (HRCs) for flu vaccination reminders.

Setting:  Michigan Care Improvement Registry (MCIR)

Population:  Children <=18 years enrolled in the Michigan Medicaid or Children’s Special Health Care Services (CSHCS) program or the Blue Cross Blue Shield of Michigan/ Blue Care Network (BCBSM/BCN) commercial health plans.  Combined, these programs provide health care coverage for over two-thirds of Michigan children.

Project Description:  To explore the feasibility of using administrative claims data to enable a statewide immunization information system (IIS) to target flu vaccine reminders for children with HRCs . HRCs were identified using ICD-9CM diagnosis codes for priority conditions indicated by ACIP influenza vaccination recommendations.  Beginning in 2006, HRCs were identified using Medicaid / CSHCS claims and provided to MCIR to populate a chronic condition indicator that triggers a pop-up reminder when a child’s record is accessed during influenza season.  Additionally, MCIR capabilities were enhanced to target mailed influenza vaccination reminders to children with HRCs.  Beginning in 2010, a parallel process was implemented in MCIR to include HRC cases identified in BCBSM/BCN commercial insurance claims.

Results/Lessons Learned:  Since 2006, over 200,000 children with HRCs have been identified in Medicaid/CSHCS claims and successfully loaded into the MCIR chronic condition indicator.  Evaluation results indicate that 89% of asthma HRC cases identified in MCIR had physician-diagnosed asthma.  Providers have endorsed the concept of expanding the chronic condition indicator to include children outside of Medicaid.   The 2010 expansion yielded  over 45,000 additional cases identified from BCBSM/BCN claims.  Administrative claims may be an effective mechanism to identify children with HRCs in IIS to improve influenza vaccination rates among priority groups such as children with chronic conditions.