1. RECIN Intervention- Working Collaboratively to Raise Immunization Rates

2. Copyright @ 2002 Marshfield Clinic2 Immunization Philosophy Because of the fractionation of immunization care, we will reach our goal of raising immunization rates ONLY through collaboration

3. Copyright @ 2002 Marshfield Clinic3 RECIN Background Web based, “live” registry Developed in the private sector Development team of private and public providers Electronic recording and tracking network that all immunization providers use to record and assess the immunization status Birth to death registry First deployed in 1995

4. Copyright @ 2002 Marshfield Clinic4 Identifying Children who are Overdue for Immunizations Set a goal Assessment –Can be county wide or facility specific –Overdue according to the current immunization schedule Targeting families who have children who are overdue for immunizations through reminder/recall systems

5. Copyright @ 2002 Marshfield Clinic5 Intervention Parameters Proactive vs. Overdue Tiered vs. non-tiered approach Identify age group to target Set location parameters Customize letters to fit individual practices Determine which immunizations to target Begin intervention

6. Copyright @ 2002 Marshfield Clinic6 Tiered Intervention Records and tracks individual patients intervention histories Moves patients through an intervention process Prevents multiple letters from going out from different providers

7. Gentle Reminder Gentle Reminder Private Provider Intervention County Population Phone List Phone List Private Provider Assessment Strong Reminder Strong Reminder Return to County Population Facility Population Complied? Yes Complied? No Complied? Yes Complied? No Complied? No Complied? Yes

8. Copyright @ 2002 Marshfield Clinic8 Public Health Intervention Public Health County Population Gentle Reminder Gentle Reminder Assessment Strong Reminder Strong Reminder Complied? Yes Complied? No Phone List Phone List Registered Letter Home Visit Home Visit Complied? Yes Complied? No Complied? Yes Complied? No Complied? Yes Complied? No Complied? Yes Complied? No Terminate Intervention

9. Copyright @ 2002 Marshfield Clinic9 Health Department’s Responsibilities Health Departments are responsible for assuring proper immunization coverage for residents in their county –HD’s run intervention on: Patients where they are the last immunization provider of record Patients who have gone through another private provider’s TIS system in their county and the patient has not responded to those intervention efforts Patients with no immunization history

10. Copyright @ 2002 Marshfield Clinic10 What makes Tiered Intervention Work? Rule 1: The last immunization provider on record is assigned the intervention responsibility for the patient

11. Copyright @ 2002 Marshfield Clinic11 Rule 2: Once a facility runs intervention for their population, it is saved to history. The history is shared with all users of the registry. –Providers can record patient specific free text that is not shared across facilities

12. Copyright @ 2002 Marshfield Clinic12 Rule 3: No facility can conduct intervention on a patient who has a history of TIS intervention in the past 6 weeks by a different facility. –Prevents multiple letters –When TIS efforts are exhausted, patient is able to be picked up by county 6 weeks after last intervention effort

13. Copyright @ 2002 Marshfield Clinic13 Patient Intervention Status A patient is marked Lost to Follow-up after all tiers have been exhausted by both private and health department –Lost to Follow-up status will be removed if they receive additional immunizations –Lost to Follow-up patients continue in the denominator of both facilities and health department’s populations Patients can opt-out of intervention A patient who becomes properly immunized will be removed from TIS

14. Copyright @ 2002 Marshfield Clinic14 Think in Multiple Dimensions Facilities have simultaneous multiple campaigns (early childhood, adult Td, kindergarten roundup …) Multiple facilities are running various campaigns on overlapping populations Not all facilities are doing intervention Patients are moving between facilities

15. Copyright @ 2002 Marshfield Clinic15 Marathon County Intervention First county to test tiered intervention 12 immunization providers in the county Started in May, 2001 with immunization rate of 81% (0-2 year olds) –4464 total patients, 779 overdue – 0-2 year old population assessing 4:3:1:3:3 status In April, 2002 the rate soared to 92.6% –4382 total patients, 323 overdue

17. Copyright @ 2002 Marshfield Clinic17 Making Intervention Work Collaboration –Provides networking opportunities to increase health status of a regional population

18. Copyright @ 2002 Marshfield Clinic18 Effective Intervention Strategies Friendly first letter – Soft approach –Good News: Less threatening, parents respond –Bad News: Parents may misinterpret importance Phone calls work –Good News: Very Effective and a great way to educate –Bad news: Hard to reach parents during regular working hours Certified letters –Good News: Very effective and parents pay attention –Bad news: Expensive

19. Copyright @ 2002 Marshfield Clinic19 What Have We Learned So Far? Tiered systems should contain at least 3 levels of intervention Get facility buy-in before running an all county run Constant communication between facilities –What is and is not working for their population Cheerleading!

20. It Takes a Community! Tina Ellis Coyle Marshfield Clinic elliscot@mfldclin.edu 715.221.8133