1. Comparing Vaccine Providers: Effect on Immunization Rates for American Indian/Alaska Native (AI/AN) Children in Arizona
Scott Hamstra, MD
Indian Health Service,
Kimiko Gosney & Michael Conklin
Arizona Department of Health Services

2. Background - ASIIS
Arizona State Immunization Information System (ASIIS) started in 1998
Majority via Vital Records (birth certificate)
State law requires licensed providers to report
Estimated ~95% of providers in AZ report
Electronic Data exchange with IHS and tribal sites began in 2004, with earnest in 2005

3. Background – AI/AN AI/AN make up 6-7% of the population in AZ
for 19–35 month olds ~9,572 (2006 census)
22 IHS or tribal facilities in Arizona
Sites submit quarterly immunization rates on month olds to IHS
16 IHS and tribal facilities currently submitting data to ASIIS electronically

4. Arizona counties and reservations

5. Background Before ASIIS existed Today, ASIIS
AI/AN vaccine rate (19-35 months) reported by
local Indian Health Service sites
and the National Immunization Survey (NIS)
Today, ASIIS
provides new opportunities to examine data
and gain new insights into AI/AN vaccines rates

6. Objectives – Use ASIIS data
To determine who provides vaccines to AI/AN children
To determine if provider choice affects coverage for AI/AN children
* Prompted by “discovery” of multiple vaccine providers for some AI/AN children

7. Methods
All children months old (on 12/31/05) in ASIIS identified as AI/AN
Compared series completion rate by provider type
Provider type categories
IHS, Private, Public, & combinations
* Medical Home = all vaccines from one provider

8. ASIIS ---- 19-35 month olds 6.5% identified as AI/AN within ASIIS
= 9,148
2006 AZ census projection
= 9,572
Bottomline: ASIIS = 96% of census, therefore = reliable denominator

9. AI/AN 43133 vaccine rate ASIIS vs. NIS and IHS
IHS sites report = 81%
NIS report = 79%
ASIIS data
IHS only sites = 82%
AI/AN overall rate = 78%
Bottomline: consistent reliable data

10. Provider Types Where do AI/AN get vaccines?

11. Provider Types - Medical Home
59%
4451
454
448

12. AI/AN 43133 rate by Provider Type
80% Goal

13. AI/AN 43133 ASIIS rates IHS vs No IHS Vaccine Provider
82%
57%
of total 6498
of total 1355
Combined rate = 78%

14. Factors impacting IHS rates
IHS uses a state-of-the-art Immunization software package with …
Forecasting
Point-of-Care data entry
Patient Tracking & Automatic Due Letters
Community Quarterly Reports with patient lists
Public Health Nursing on reservations
Electronic Data export

15. Conclusions
The Arizona State Immunization Information System (ASIIS) has reliable data that can be examined in previously unavailable ways.
ASIIS demonstrates that more than ½ of AZ AI/AN children use multiple vaccine providers
AI/AN children who get vaccine at any IHS site have high rates
AI/AN children who use a Single Vaccine Provider have LOWER completion rates than those who use multiple providers