Pandemic Preparedness: Identifying and Reaching Priority Cases Using An IIS

Background: 

Children with chronic conditions have increased risk of complications from influenza and are considered priority cases for flu vaccination.  Mechanisms to improve outreach to priority cases are needed and may be especially important during pandemic events.

Setting:  Michigan Care Improvement Registry (MCIR).

Population:  Since 2006, children in Michigan with high risk conditions (HRCs) have been identified using administrative claims, which then populate an indicator in MCIR.   The MCIR ‘high risk indicator’ enables targeted flu vaccination reminders to priority cases.

Project Description:  During the 2009-2010 H1N1 pandemic, the Michigan Department of Community Health (MDCH) used the MCIR high risk indicator and age-based risk criteria to identify priority cases for flu vaccination reminders.   A series of reminders were mailed to encourage priority cases to obtain H1N1 and seasonal flu vaccinations from their primary care provider or local health department.  A retrospective evaluation was conducted to assess the feasibility of using MCIR to gauge real-time flu vaccination rates among priority cases and to evaluate the effectiveness of mailed reminders to priority cases.

Results/Lessons Learned: MDCH conducted four successive reminder mailings targeting priority cases: December 2009, children 6 months – 19 years, with HRCs needing first H1N1 (n=202,330); February 2010, all children 6 months – 10 years needing second H1N1 (n=169,437); March 2010, children 6 months – 10 years with HRCs needing second H1N1 (n=14,286); and March 2010, all children 6 months – 3 years needing first H1N1 (n=235,323).  Through November 26, 2009, 65% of H1N1 doses had been administered but only 45% were entered into MCIR; by the week of January 28, 2010, 95% had been administered and 90% had been entered into MCIR.  Data entry lags were greater for H1N1 than seasonal flu vaccine, but similar by risk status (HRC, no HRC).  Evaluation results indicate considerable variability in the effectiveness of reminder notification among priority cases.