Using the Registry to Conduct WinCASA Assessments: Lessons Learned San Diego Immunization Partnership (SDIP) San Diego Regional Immunization Registry (SDIR) 5/24/2019

Objective Describe the manual and integrated (Registry) immunization audit process Identify the benefits and challenges of new process 5/24/2019

SDIP The San Diego Immunization Program Established in 1992 County of San Diego HHSA the lead agency Collaborative of community agencies and programs Access and availability of immunization services Community education and outreach Assessment and evaluation 5/24/2019

SDIR The San Diego Regional Immunization Registry Established in 1997 Enhancements to web application Data exchange with Imperial County PROW assessment site Health Plan interactions Latest stats: over half million clients with IZ records 5/24/2019

Latest Statistics: San Diego Total patients 404,946 < 6 years 110,115 6-18 years 247,904 > 18 years 46,927 Imperial 95,492 37,659 53,689 4,114 5/24/2019

SDIR Participating Practices San Diego Public Health 21 (paperless) Community Clinics 23 Private Providers 11 Other 13 (CalWORKs, Foster Care, County Social Services) Imperial 8 2 5/24/2019

WinCASA Audits Background Immunization assessment initiated in 1993 All PHC and CHC received subvention contract funds Audits occur once a year Half year process from start to finish Manual chart review process prior to availability of SDIR 5/24/2019

WinCASA Audit Methods Billing lists 250 clients randomly selected 24-36 month of age Active criteria Made at least two visits to the clinic No documentation of having moved or gone elsewhere for services WinCASA Coverage levels at 24 months of age 5/24/2019

Integrated Assessment Process for PHC 5/24/2019

Integrated Assessment Process for CHC 5/24/2019

Some Numbers on 2003 Immunization Assessment Number of clinics and centers using registry: 33 PHC-13 and CHC with SDIR-20 Birth cohort: 2000 Eligible population: 10,355 (range from 0 to 1,244) PHC-2,893 and CHC-7,462 Sample size: 6,904 PHC-2,893 and CHC-4,011 CHC clients info (name and DOB) found in SDIR: 78% 5/24/2019

Immunization Coverage Level Immunization Coverage Level* by Data Source San Diego Public Clinics, 2000-2003 * Immunization coverage level defined by 4-DTP, 3-POLIO & 1-MMR 5/24/2019 07/03/03 I:\Eval|Audit2002\graph\Audit_akc_2002.ppt

Immunization Coverage Level Immunization Coverage Level* by Data Source San Diego Public Clinics, 2000-2003 Year of Assessment * Immunization coverage level defined by 4-DTP, 3-POLIO & 1-MMR 5/24/2019 07/03/03 I:\Eval|Audit2002\graph\Audit_akc_2002.ppt

Benefits of Integrated Process Decreased staff time Abstractor Data enter Verification of data entry Minimizing process errors Paper handling Data quality Opportunity for clinic staff to clean up registry Update IZ date from charts Link multiple records Update memo and MOGE status from charts Correct data entry error Immunization Coverage Rates Provides more accurate data Decreased staff time Abstractor Data enter Verification of data entry Minimizing process errors Paper handle Data quality Opportunity for clinic staff to clean up registry Update IZ date from charts Link multiple records Update memo and MOGE status from charts Correct data entry error Immunization Coverage Rates Recall phones or cards “True” coverage levels 5/24/2019

Challenges of Integrated Process Complicated internal process Staff training Multiple software (Word, Excel, Access) Requires high level of programming Match merge Import/export Complex database management Multiple sites Multiple data sources Complicated internal process Staff training (billing, WinCASA, update) Multiple software (Word, Excel, Access, WinCASA,) Manually verify “inactive” status in the registry Requires high level of programming Match merge Import/export Complex database management Multiple sites Multiple data sources 5/24/2019

Conclusion More efficient data gathering process Benefit to SDIR and practices “Clean” and updated data Records from multiple sites Database management more complicated Improved data quality results in more streamlined process Reinforces value of registry for practices 5/24/2019