Childhood Immunization Rates Increasing Childhood Immunization Rates A Successful Partnership with the WI Department of Health and Family Services Sue Scholz, Childhood Immunization Initiative Coordinator Scott McCarten, System Specialist

A not-for-profit integrated health care system Serving 75 communities in 20 counties of Eastern Wisconsin Consists of: 14 Hospitals 120 Clinics 136 Community Pharmacies

National Immunization Survey: Estimated vaccination coverage with the 4:3:1:3* series among children aged 19-35 months by state: 7/97-6/98 Wisconsin 77% % of children covered States *4 DTP, 3 Polio, 1 MMR, 3 Hib

Comparative Data for 2000 State of Wisconsin 77.6% Milwaukee County 62.9% Aurora baseline results 58.0%

Primary Intervention: Use of Automated Registry Research findings: Public health departments that use an automated registry have demonstrated improved immunization rates. Conclusion: Use of the DHFS Wisconsin Immunization Registry will allow us to: track immunization histories identify children in need of immunizations track vaccine inventory generate reminder notices.

Wisconsin Immunization Registry Developed by the DHFS 16,000 users 4.2 million clients 28 million immunizations 1100 providers 2750 schools 5,500 immunizations entered per day via PC 7,000 entered per day via interface

Aurora’s Action Steps Gained approval from Quality Council Set initiative goal Trained selected staff and piloted WIR in one region in early 2002 Established goals and measurement for organization-wide implementation Roll-out, organization-wide, in 2003

Aurora Health Care’s Childhood Immunization Initiative Align with Healthy People 2010 goal of 90% immunization rate (primary series) in children up to 24 months of age Incremental goals established each year Current goal: 80% immunization rate in children up to 24 months (4:3:1:3:3:1)

Strong Working Partnership with DHFS to Support Initiative Clinic visits by state reps WIR Help Desk consistently available State training sessions made available to Aurora staff Regular updates, presentations to initiative team by WIR Manager

Organization-Wide Process Changes to Support Initiative Vaccine for Children Program made available to every clinic Training of 1400+ clinic staff by DHFS Backup support from IS staff Interface download of birth dose Hep B into WIR Pre-visit printouts of WIR immunization histories

Organization-Wide Process Changes to Support Initiative (cont’d) WIR Administrator Infrastructure at clinic, regional, and organizational levels Clinic specific reports Ongoing communication through site visits, persistent clinic contact, organization-wide e-newsletters, intranet, WIR WIRe

Aurora’s Results to Date

Challenges, Barriers Employee ‘buy-in’ Physician ‘buy-in’ Use of inventory function; paper to electronic Time to ‘clean-up’ reports Multiple documentation; Cerner and WIR Physician ‘buy-in’ Gaining trust in the WIR schedule and recommendations

Lessons Learned Aurora’s results further support the use of an automated registry Partnership with DHFS was integral to success of entire project Smaller pilot project allowed us to “work out kinks” and learn valuable lessons for organization-wide implementation Still many opportunities for improvement

Opportunities for Future Improvements Interventions to increase rates in inner city populations WIR to Cerner interface Expand to hospitals, EDs Expand the initiative to adolescents and adults

Aurora Regional Results

Opportunities for Future Improvements Interventions to increase rates in inner city populations WIR to Cerner interface Expand to hospitals, EDs Expand the initiative to adolescents and adults