1. Improving Regional Infertility Prevention Project (IPP) Data Quality and Completeness
2008 National STD Prevention Conference
Chicago, Illinois
March 12, 2008
Rabins C1, Holmes S1, Cash S2, Region V IPP Advisory Committee3
1STD Program, Illinois Department of Public Health, Springfield, IL, USA
2,3 Health Care Education and Training, Carmel, IN, USA

2. Background - 1
Goal of Region V* Infertility Prevention Project (IPP) Reduce Prevalence of Chlamydia and Resultant Complications By Screening and Treating At-Risk Persons
* Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin

3. Background – 2 High Quality and Complete IPP Data are Essential For:
Determining What Populations to Screen
Conducting Program Evaluation and Improvement
Allocating Resources Effectively
Identifying and Reducing Health Disparities

4. Background – 3 Anecdotal Data Indicated That Date Completeness and Quality for RVIPP Screening Data Improved From 2002 to 2006

5. Objective
Determine Where and How Rate of Missing/Unknown Variables for Key Demographic Variables Improved
Determine Best Practices for Achieving High Rates of Data Completeness and Quality

6. Methods
2002 to 2006 RVIPP Screening Data Were Analyzed By Region, State and By Demographic Element to Determine Rate of Missing/Unknown Key Variables
States With High Data Completeness Rates Were Contacted to Determine Best Practices and States With Low Rates Were Contacted to Identify Barriers

7. Results

8. Improvement in RVIPP Rate of Unknown Data Demographics All Screening Sites, 2002 and 2006
Percent
Unknown
Number of
Unknowns
2006
Percent Change
2002 to
Sex
0.4%
1,890
0.1%
761
- 59.7%
Age
0.3%
1,553
0.2%
907
- 41.6%
Race
15.6%
82,872
7.8%
42,108
- 49.2%
Ethnicity
24.2%
128,736
17.0%
91,765
- 28.7%
Despite 1.6% increase in total IPP Reported Tests, Data Completeness Improved Significantly
2002 N = 532,033
2006 N = 540,769

9. Changes In Unknown Race By RVIPP State, 2002 and 2006
Percent Race
Unknown
2006
Unknown Race
Records
Total IPP
Percent
Total 2006
RVIPP Race Unknown
Illinois*
6.8%
0.6%
1,105
195,948
2.6%
Indiana
0.4%
8.6%
5,479
63,758
13.0%
Michigan
42.2%
16.1%
16,115
99,853
38.3%
Minnesota
5.3%
8.0%
2,246
28,138
Ohio*
0.1% 43
78,602
Wisconsin
30.6%
23.0%
17,120
74,470
40.7%
RVIPP
15.6%
7.8%
42,108
540,769
100.0%
2 States Michigan and Wisconsin accounted for 79% of all unknown race
* State Uses Active QA Process

10. Changes In Unknown Ethnicity By RVIPP State, 2002 and 2006
Percent Ethnicity
Unknown
2006
Percent
Ethnicity
Records
Total IPP
Records**
Total 2006
RVIPP Ethnicity Unknowns
Illinois*
11.2%
0.6%
1,204
195,948**
1.3%
Indiana
1.8%
5.3%
3,362
63,758
3.7%
Michigan
46.1%
65.0%
64,917
99,853
70.7%
Minnesota
7.8%
1.9%
526
28,138
Ohio*
0.1% 60
78,602
Wisconsin
52.0%
29.3%
21,796
74,470
23.7%
RVIPP
24.0%
17.0%
91,865
540,769
100.0%
Note increase in Michigan compared to decrease in Race
Still high number of records with unknown ethnicity
2 States Michigan and Wisconsin accounted for 94% of all unknown Ethnicity
* State Uses Active QA Process
** All IPP Labs

11. Example Best Practice - 1 Improving IPP Data Completeness in Illinois and Ohio With Active Follow-up With Specimen Submitter
Line List & Memo Sent to All Illinois IPP Specimen Submitters Monthly for Records With 1 or More Missing Key Data Elements
Sex, DOB, Race, Ethnicity and Zip Code
Specimen Submitter Requested to Complete Missing Data Element Report and Send to Illinois STD Program
STD Program Staff Enter Missing Data into IPP Database Upon Receipt

12. IDPH Original Line List Report Sent to Specimen Submitters

13. IDPH Submitter Letter For Non-Payers

14. IDPH Submitter Letter For Payers

15. IDPH Lab Record Update Search Screen

16. IDPH Lab Record Update Screen

17. Adversity is The Mother of Invention
Cost approximately $150 for wired gun to $500 for wireless

18. IDPH Line List Report Sent to Specimen Submitters

19. *Line List Mailed to Specimen Submitters
Improvement In 2006 Data Quality Resulting From Illinois IPP QA Process*
Data Field
Originally
Unknown
% Orig.
Fixed
Final
% Final %
Ethnicity
5,738
3.49%
5,288
450
0.27%
92.2%
Race
4,274
2.60%
3,919
355
0.22%
91.7%
DOB
1,100
0.67%
969
131
0.08%
88.1%
Sex
137
128 9
0.01%
93.4%
Zip Code
3,046
1.85%
2,177
869
0.53%
71.5%
IDPH labs account for approximately 84% of total Illinois test data submitted to IPP – Cook County Jail
Approximately 500/month missing ethnicity
N = 164,431 (IDPH Labs)
*Line List Mailed to Specimen Submitters

20. Quality of Chlamydia and Gonorrhea Records, Lab Test Payers vs
Quality of Chlamydia and Gonorrhea Records, Lab Test Payers vs. Non-Payers Illinois By Race 2005 vs. 2006
2005
Total
Tests
Unknown
Race
Percent
2006
Non-Payers
176,227
2,441
1.4%
162,831
494
0.3%
Payers
4,718
103
2.2%
5,930 23
0.4%
Payers represent 2.6% of total Tests
Non-payers decreased by 7.6% (13,396) – most likely as a result of our program to reduce screening in low risk women
Payers increased by 25.7% (1,212) tests – some providers moved from non-payers to payers

21. Quality of Chlamydia and Gonorrhea Records, Lab Test Payers vs
Quality of Chlamydia and Gonorrhea Records, Lab Test Payers vs. Non-Payers Illinois By Ethnicity, 2005 vs. 2006
2005
Total
Tests
Unknown
Ethnicity
Percent
2006
Non-Payers
176,227
3,807
2.2%
162,831
645
0.4%
Payers
4,718
136
2.9%
5,930 42
0.9%
Payers represent 2.6% of total Tests
Non-payers decreased by 7.6% (13,396) – most likely as a result of our program to reduce screening in low risk women
Payers increased by 25.7% (1,212) tests – some providers moved from non-payers to payers

22. Quality of Illinois Chlamydia and Gonorrhea IPP Data By Provider Type For Race and Ethnicity, 2006
Total
Tests
Total Race
Unknown
Percent
Race
Total Ethnicity
Ethnicity
Adult Jail
2,007 1
0.05%
0.00%
1.2%
Community HC
18,560 15
0.08% 23
0.12%
11.1%
Family Planning Clinic*
73,201
170
0.23%
200
0.27%
43.8%
Juvenile Detention
5,992
0.02%
3.6%
School Based Clinic
6,119 84
1.37%
129
2.11%
3.7%
STD Clinic
48,174 12
0.03%
28.8%
Other
12,976 41
0.32% 47
0.36
7.8%
* 76% (90/116) & 80% (93/116) of FP Clinics had 0 Unknown Race or Ethnicity, Respectively
IDPH Lab Users

23. Ohio DPH Submitter Letter – Page 1

24. Ohio DPH Submitter Letter – Page 2

25. Ohio DPH Line List Report Sent to Specimen Submitters

26. Example Best Practice – 2 Improving IPP Data Completeness in Illinois IDPH IPP and CDPH Clinics Database Match
Monthly Mailed Line List to Chicago Dept. Public Health (CDPH) Clinics was Problematic Because of Staff Issues – Alternative Automated System Developed
Electronic File With Missing Key Data Elements ed Monthly to CDPH
CDPH Matches File With Global Clinics Database and Returns to IDPH With Updated Records
IDPH Updates IPP Database

27. *IDPH Labs Specimen Submitters
Improvement In 2006 Data Quality Resulting From IDPH IPP - CDPH Global QA Non-STD Clinics Database Match Process*
Data Field
Originally
Unknown
% Orig.
Fixed
Final **
% Final %
Ethnicity
456
7.3%
352
104
1.6%
77.2%
Race
544
8.7%
436
108
1.7%
80.1%
Zip Code
5.6%
280
164
2.6%
80.0%
N = 6,257
*IDPH Labs Specimen Submitters

28. Using IPP Data to Improve Completeness of Incidence Data Illinois (Excluding Chicago) Database Match Change in Reported Chlamydia Cases, 1998 to 2006

29. Using IPP Data to Improve Completeness of Incidence Data Illinois (Excluding Chicago) Database Match Percent Change in Reported Chlamydia Cases, 1998 to 2006

30. Using IPP Data to Improve Completeness of Incidence Data Illinois (Excluding Chicago) Database Match Change in Reported Gonorrhea Cases, 1998 to 2006

31. Using IPP Data to Improve Completeness of Incidence Data Illinois (Excluding Chicago) Database Match Percent Change in Reported Gonorrhea Cases, 1998 to 2006

32. Using IPP Data to Improve Quality of 2006 Illinois (Excluding Chicago) Chlamydia and Gonorrhea Incidence Data
2005
2006
Change
Percent
Unknown
Percent of Total 2005 Cases
Percent of Total 2006 Cases
Race
5,680
4,770
-910
-16.0%
15.0%
11.9%
Ethnicity
8,888
5,090
-3,798
-42.7%
23.5%
12.7%
Although reported cases increased 5.1%, reported unknowns decreased 16.0 and 42.5 percent respectively
2005 N = 37,835
2006 N = 40,229

33. Recommendations to Improve Quality and Completeness of IPP Prevalence and STD Program Incidence Data
Conduct Periodic QA Review and Implement Passive or Active Follow-up of Key Data Fields
Assume Most Specimen Submitters Will Correct Records With Missing Data if Asked
Use Database Matches for Bi-Directional Improvement of Prevalence and Incidence Data

34. Acknowledgements Health Care Education and Training (HCET)
State RVIPP Coordinators and Data Managers
State RVIPP Laboratory and Testing Site Staff
IDPH and CDPH STD Program Staff

35. Questions?

36. Improving Regional Infertility Prevention Project (IPP) Data Quality and Completeness
2008 National STD Prevention Conference
Chicago, Illinois
March 12, 2008
Charlie Rabins, MPH
Chief, Sexually Transmitted Diseases Program
Illinois Department of Public Health
Springfield, IL
( )