1. Daniel Hopfensperger Program Manager Wisconsin Immunization Program
Using Immunization Information Systems and Performance Based Contracts to Improve Childhood Immunization Rates
Daniel Hopfensperger
Program Manager
Wisconsin Immunization Program

2. Outline Performance Based Contracts National Immunization Survey
Core Functions of Public Health
Population based assessments
Wisconsin Immunization Registry
Continuous Quality Improvement

3. Performance Based Contracts
Serves as basis for providing funds to local health departments (LHDs)
Process began in CY2000
Objectives must be observable and measurable
Process objectives not allowed
Cost and outcomes for each objective negotiated
Original focus was for LHDs to reach 90% goal for children they serve based on a CASA assessment
Originally included recoupment for non-attainment

4. Immunization Program Boundary Statement
The boundary statement sets the parameters of the program within which the LHD, Tribe or agency will need to set its objectives. The boundaries are intentionally as broad as federal and state law permit to provide maximum flexibility. However, if there are objectives or program directions that the program is not willing to consider or specific programmatic parameters, those are included in the boundary statement.
LHDs, Tribes and agencies are encouraged to leverage resources across categorical funding to achieve common program goals. The Wisconsin Immunization Program aligns well with the boundaries of the WIC and MCH Programs.

5. Boundary Statement Long-term goals Target Populations
Continuous Quality Improvement (CQI)
Target Populations
Optimal of Best Practice Guidance
Unacceptable Proposals
Relationship to State Health Plan:
Healthiest Wisconsin 2010

6. Immunization Program Quality Criteria
Generally high program quality criteria for the delivery of quality and cost-effective administration of health care programs have been, and will continue to be, required in each public health program to be operated under the terms of the contract. Contractees indicate the manner in which they will assure each criterion is met for the program.

7. Quality Criteria Include: Assessment and surveillance
Delivery of public health services
Record keeping
Information, education, and outreach
Coordination
A referral network
Provision of guidance to staff
Financial management practices
Data collection, analysis and reportiing

8. National Immunization Coverage Benchmark 4:3:1:3:3:1
Wisconsin 2005 NIS data: 77.1%
National 2005 NIS: %
Wisconsin 2006 NIS data: 80.5%
National 2006 NIS data: 77.0%
Be sure to point out/acknowledge that the NIS data is differernt than WIR data.

9. Wisconsin Immunization Program NIS Data 2005-2006 By individual Sentinel Antigens

10. Wisconsin Immunization Program NIS Data 2005-2006 By Individual Antigen

11. NIS Survey Results
Although Wisconsin did not lose ground, we did not grow as other states did. Our goal is to increase immunization rates so that we can assure that we will achieve the 2010 goals of 90% coverage for 4:3:1:3:3:1

12. Core Functions of Public Health
Assessment
Policy Development
Assurance

13. Population based objectives
By December 31, 2008 __% of infants born to families residing in __ Health Department jurisdiction who turn 24 months of age during the contract year will have received 4 DTaP, 3 Polio, 1 MMR, 3 Hib 3 Hepatitis B and 1 varicella vaccination.
Agencies must attain or be making progress towards the goal of 90%
Accomplishment will be based on % increase according to the table in the context section

14. Context
Guidelines for determining increase needed for progress towards 2010 goals
If current baseline is: Increase required: <50% 10% % 5% % 4% % 3% % 2% % 1% >90% maintain

15. Wisconsin Immunization Registry (WIR) Statistics as of March 08
5.9 Million Client Records
38 Million Immunizations
15,000 Immunizations entered per day
1,200 Providers at 3,500 sites
76 Hospitals with access (60 entering data)
14,000 active users
1,000 active users between 7:30 - 4:30
2,747 Schools using the registry
9,000 Public Access per Month

16. WIR Benchmark Report Birth date between 01/01/2005 – 12/31/2005
Date report generated
Generated by
Name of health department
Clients residing in county
Both clients that DID or did NOT meet selected benchmark(s)
Just consider immunizations meeting benchmark
Birth date between 01/01/2005 – 12/31/2005
Evaluation date: 01/01/2008
Benchmark 24 months
Selected benchmarks: DTaP (4), Hep B (3), Hib (3), MMR (1), Polio (3), Varicella (1)
Total clients: 602 clients (81%) met all benchmark criteria, 143 clients (19%) did not

17. Wisconsin Immunization Program Number of Counties in Each Coverage Rate Range By Year 4:3:1:3:3:1 series by 24 Months of Age – 2006 Data Source: Wisconsin Immunization Registry (WIR) Benchmark Report
Update with 2007 data

18. Value expressed as percentage
24 month Immunization Rates- 4 DTaP, 3 Polio 1 MMR, 3 Hib, 3 Hep B, 1 Varicella WIR Data Birthdate Range 01/01/2005 to 06/30/2005 Evaluation Date 07/01/2007 Data Source: WIR
Key
Value expressed as percentage
Under 50
50 to 59
60 to 69
70 to 79
80 to 89
90 and above
This graph WI’s regional Immunization Data based on WIR reports “Wanna be Green”

19. Key Challenges
Identification and inclusion of all partners, concerns, barriers and perceived relevancy
Challenges with border counties/states
Challenges with Pocket of Need
GIS to county level only
Interface with all immunization registries i.e., RECIN, Internal systems

20. Key Challenges
How to raise awareness and consistant use Immunization Registries, i.e. WIR, EMR/billing
The completeness of immunization registry data directly impacts registry usefulness.
Need to address:
Lack of provider participation in registries (staffing, willingness, technical skill set, cost, interface with EMR, etc.)
Assess accuracy of data entry

21. CQI Immunization Goals Overview
What are the Immunization CQI goals?
Assess where we are now (public and private)
Identify strategies to improve immunization rates per county or jurisdiction
Include all partners in identifying and addressing all priority concerns

22. Key Questions to Identify areas of Priority Concerns!
How do you determine who is uninsured or underinsured in your community?
Which area providers are not yet WIR users or are not using WIR effectively?
What is the immunization coverage rate of the people in your community, to include special populations, i.e. WIC, adults, adolescents, elderly, immigrants/migrants?

23. Key Questions to Identify areas of Priority Concerns!
How do you determine what the immunization coverage rate is of your special populations?
What are the health priorities of the community as identified by the Community Health Improvement Process Survey (CHIPS)?

24. Our CQI process will build on our strengths--
Wisconsin Immunization Registry (WIR)
Electronic immunization data collection and storage system
Secure, confidential, convenient (Web based)
Free
WIR is the best tool we have in our assessment arsenal for coverage at the local level

25. For more information please contact:
Daniel Hopfensperger
Program Manager
Wisconsin Immunization Program
Phone: