1. Using the National Change of Address Database to Locate Children Designated as Moved or Gone Elsewhere CHEAR Unit, Division of General Pediatrics, University of Michigan Kevin Dombkowski, DrPH, MS April 19, 2010

2. Learning Objectives Review of MOGEs and implications for immunization registries Explore how the National Change of Address (NCOA) can mitigate MOGEs Explore potential strategies for adoption by registries

3. MOGE Defined

4. Simplified reminder / recall process

6. MOGEs Defined Defined by American Immunization Registry Association (AIRA) ** Distinct guidelines established for providers and geographic jurisdictions “Inactive – MOGE”: –Documentation showing that an individual does not reside in the geographic jurisdiction Verbal, postal, other documentation ** Modeling of Immunization Registry Operations Workgroup (MIROW) http://www.immregistries.org/pubs/mirow.phtml

7. MOGE Implications MOGE status impacts on registries: –reminder / recalls can’t be successfully mailed to bad addresses –vaccination coverage assessments may be inaccurate –improving coverage among the unreachable is difficult May differ from one registry to another

8. USPS Change of Address Process

19. NCOA Link Product Computerized list of updated COA information licensed by the US Postal Service Software is purchased, leased, or developed by a licensee to access NCOA Link data

20. NCOA Link Product Amount of information depends on the product purchased by licensee: –48 months of data (~160,000,000 records) –18 months of data (~ 48,000,000 records) Updated, computerized COA information provided to licensees weekly

21. Using NCOA Link with a Statewide IIS

22. Objective Assess the degree to which updated contact information can be obtained for persons with MOGE status in a statewide IIS Use the USPS National Change of Address (NCOA Link ) process

23. Study Design Collaboration with: –Immunization officials from the Michigan Department of Community Health (MDCH) –Michigan Care Improvement Registry (MCIR)

24. Study Design Children ≤19 yrs. with MOGE status in the Michigan Care Improvement Registry (MCIR) Focused on 12 local health jurisdictions comprising 15 counties in southwest Michigan MOGEs identified August 2009

26. Study Design MOGEs with complete addresses sent to NCOA vendor for 2 match attempts: –parent name –child name Matched cases evaluated by child characteristics

27. NCOA Matching

28. NCOA Matching Process Must begin with a standard address to search for matches with NCOA Link product 3 step process to verify completeness, internal consistency, validity Address standardization

29. Standardization Process 1.Address compared to valid range of addresses assigned to a street 2.If valid, then address compared against database of valid delivery points 3.Converts rural route and highway contract addresses to city-style addresses

30. Standardization Success 66,338 MOGEs identified –~9% of children ≤19 yrs. in study area 19,600 (30%) could be standardized Standardization success varied across child characteristics

31. Standardization Success (n=66,338)

33. Forwarding Address Matching Success 19,600 standardized addresses 15% matched a forwarding address: –14% matched based on parent name –1% matched based on child name 5% of initial MOGE sample matched a forwarding address

34. Matching Success (n=19,600)

37. Conclusions NCOA Link process can be used to located forwarding addresses for children designated as MOGE Highest degree of matching success is among young children and least successful among adolescents Other strategies to reconcile MOGEs are warranted, especially among adolescents

38. Non-MOGE Population

39. Non-MOGE Populations Tested NCOA process using reminder / recalls in several areas (>9,200 notices): –Detroit / Wayne County –Kalamazoo, Kent, Ottawa Counties Higher success rate for non-MOGEs: –Standardization: 96% (vs. 30%) –Matching with new address: 26% (vs. 15%)

40. Can NCOA Solve All of My Address Problems?

41. Birth Record 123 S. Main St. Kalamazoo, MI Child with History of Multiple Moves 0 – 2 years2 – 4 years4 – 6 years6 – 8 years

42. Birth Record 123 S. Main St. Kalamazoo, MI Move #1 501 N. Main St. Kalamazoo, MI Child with History of Multiple Moves 0 – 2 years2 – 4 years4 – 6 years6 – 8 years

43. Birth Record 123 S. Main St. Kalamazoo, MI Move #1 501 N. Main St. Kalamazoo, MI Move #2 6060 Elm St. Portage, MI Child with History of Multiple Moves 0 – 2 years2 – 4 years4 – 6 years6 – 8 years

44. Birth Record 123 S. Main St. Kalamazoo, MI Move #1 501 N. Main St. Kalamazoo, MI Move #2 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI Child with History of Multiple Moves 0 – 2 years2 – 4 years4 – 6 years6 – 8 years

45. Current 2020 Oak St. Lansing, MI NCOA Database 2 – 4 years ago 2 yrs. – present 4 – 6 years ago 6 – 8 years ago

46. Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 2 – 4 years ago 2 yrs. – present 4 – 6 years ago 6 – 8 years ago NCOA Database

47. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 2 – 4 years ago 2 yrs. – present 4 – 6 years ago 6 – 8 years ago NCOA Database Limited to last address change in 48 months

48. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 2 – 4 years ago 2 yrs. – present 4 – 6 years ago 6 – 8 years ago NCOA Database IIS match attempt Current ? MOGE Address 501 N. Main St. Kalamazoo, MI

49. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 2 – 4 years ago 2 yrs. – present 4 – 6 years ago 6 – 8 years ago NCOA Database IIS match attempt Current ? MOGE Address 501 N. Main St. Kalamazoo, MI

50. Implications Using the NCOA process cannot resolve all MOGE address issues May be part of a long-term strategy to improve IIS address data

51. Implications Most MOGEs that cannot be used with NCOA are null addresses, i.e., address ‘unknown’ Finding an address to attempt the NCOA process may facilitate improved NCOA matches

52. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 2 – 4 years ago 2 yrs. – present 4 – 6 years ago 6 – 8 years ago NCOA Database Cannot match with NCOA history older than 48 months

53. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 4 – 6 years ago 6 – 8 years ago NCOA Database Match IIS record with alternative source that has more current address Medicaid History 6060 Elm St. Portage, MI

54. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 4 – 6 years ago 6 – 8 years ago NCOA Database Medicaid History 6060 Elm St. Portage, MI Match alternative address with NCOA

55. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 4 – 6 years ago 6 – 8 years ago NCOA Database Use NCOA to find current address

56. ?? Prior Address 6060 Elm St. Portage, MI Current 2020 Oak St. Lansing, MI 4 – 6 years ago 6 – 8 years ago NCOA Database Refresh IIS with current address from NCOA Current 2020 Oak St. Lansing, MI

57. Next Steps Test the success of this approach: Medicaid WIC Drivers license Head Start Health plans

58. Acknowledgements Many thanks to my collaborators at: –University of Michigan –Michigan Dept. of Community Health –Michigan Care Improvement Registry –Detroit, Wayne, Kalamazoo, Kent, and Ottawa County Health Departments –Centers for Disease Control and Prevention

59. Thank you for your attention! kjd@med.umich.edu