1. University of Michigan Health System Primary Care Providers’ Perspectives on a Registry-Based Indicator to Identify High-Risk Children for Influenza Vaccination Sarah Clark, Kara Lamarand, Kevin Dombkowski Child Health Evaluation and Research (CHEAR) Unit University of Michigan April 20, 2010

2. University of Michigan Health System Background ACIP Influenza Immunization Recommendations: Flu Season 6-23 mo. 23-<59 mo. 59 mo.-18 yr. Children with HRCs 2005-2006● ● 2006-2007●● ● 2007-2008●● ● 2008-2009●●●● 2009-2010●●●●

3. University of Michigan Health System Background Despite longstanding recommendations, vaccination rates remain low: –any chronic condition: 35% –asthma: 29% Missed opportunities for flu vaccination: –are more common than vaccination –often occur in successive flu seasons – 40%

4. University of Michigan Health System Background In 2006, Michigan Department of Public Health (MDCH): –began a new initiative to improve influenza vaccination among children with chronic conditions –built upon the Michigan Care Improvement Registry (MCIR) to identify children with chronic conditions

5. University of Michigan Health System MCIR High-Risk Indicator Identified children with chronic conditions using administrative data from: –Medicaid –Children’s Special Health Care Services Statewide: 7% of children ≤18yrs

6. University of Michigan Health System MCIR High-Risk Indicator Enhanced the MCIR to: –identify children with chronic conditions –offer a “point of contact” provider reminder about flu vaccination

7. University of Michigan Health System MCIR High-Risk Indicator

8. University of Michigan Health System Research Questions Do providers see the indicator when children present for office visits? Do providers perceive that the indicator is useful in reminding them to offer flu vaccine?

9. University of Michigan Health System Objective To evaluate the extent to which children’s primary care providers in Michigan are aware and make use of the MCIR high-risk indicator.

10. University of Michigan Health System Methods Cross-sectional mail survey with 16 fixed-choice survey items. Fielded in July-August 2009. Sample of primary care providers for children enrolled in Medicaid managed care: 300 pediatricians (Peds), 300 family physicians (FPs)

11. University of Michigan Health System Results Overall response rate was 79% 84% Peds vs 73% FPs 91% Peds vs 71% FPs had VFC flu vaccine in 2008-09 season

12. University of Michigan Health System Results 99% Peds vs 92% FPs currently use MCIR Among MCIR users, 91% usually and 9% sometimes have MCIR immunization information prior to or during well- child visits 52% usually and 32% sometimes have MCIR immunization information prior to or during sick visits.

13. University of Michigan Health System Results Among MCIR users, 32% Peds vs 17% FPs recalled seeing the high- risk indicator during the 2008-09 flu season 49% Peds vs 36% FPs reported that their staff saw the high-risk indicator

14. University of Michigan Health System Results Overall, 27% of respondents rated the high-risk indicator as helpful or very helpful in identifying which children should receive flu vaccine Among those who saw the indicator, 48% rated it as helpful or very helpful

15. University of Michigan Health System Results Reasons to NOT use the MCIR high-risk indicator: 33% providers can identify high-risk patients within practice 24% no need to target high-risk children because of universal flu recommendation 22% concerns about accuracy of data 23% general problems accessing MCIR 6% already get list of high-risk patients from health plans

16. University of Michigan Health System Results Ways to improve the MCIR high-risk indicator: 71% generate a list of high-risk children in my practice 58% assist in generating flu vaccine reminder notices for my high-risk children 46% include children from private insurance plans, as well as Medicaid

17. University of Michigan Health System Results Preferences for tracking children’s high-risk status: 77% MCIR, for all children 2% MCIR, for Medicaid children only 4% each health plan, independently 24% within my practice

18. University of Michigan Health System Conclusions MCIR use is ubiquitous among children’s primary care providers. Use of the high-risk indicator is less common overall, and lower among FPs than Peds. In practices where providers or staff have seen the pop-up screen, the indicator is rated as helpful.

19. University of Michigan Health System Conclusions Primary care physicians clearly prefer the consolidation of high-risk information in MCIR for all children. Providers also seek assistance with flu vaccine reminders. Future efforts are underway in these areas.

20. University of Michigan Health System Acknowledgments Funded by the Blue Cross Blue Shield of Michigan Foundation Technical support from the Michigan Department of Community Health