1. Regional Early Childhood Immunization Network (RECIN) Producing and Measuring Quality Outcomes for At-Risk Children Tina Ellis Coyle Marshfield Clinic Marshfield, WI

2. October 28, 2005Copyright @ 2005 Marshfield Clinic2 Why Do We Need Registries?  Immunizations may have been the #1 public health advancement in the 20th Century, however...  Barriers to children being properly immunized include – complex immunization schedule – fragmentation of care – Calls from provider to provider are time consuming and costly

3. October 28, 2005Copyright @ 2005 Marshfield Clinic3 Requirements of a Successful Registry  Centralized repository accessible to both public and private immunization providers  Provide one common immunization record for each patient  Collect and retain all data required for giving an immunization  Assess and intervene on patients who are not immunization current

4. October 28, 2005Copyright @ 2005 Marshfield Clinic4 RECIN Background  Web based, real-time registry  Developed in the private sector, Marshfield Clinic  Development team collaboration of private and public providers  Electronic recording and tracking network that all immunization providers could use to record and assess immunization status of shared patients  Captures immunizations across the lifespan  First deployed in 1995

5. October 28, 2005Copyright @ 2005 Marshfield Clinic5 Mission The mission of RECIN is to provide a shared population based immunization recording, tracking and intervention repository that assists communities in raising childhood and adult immunization rates.

7. October 28, 2005Copyright @ 2005 Marshfield Clinic7 Intervention: It Takes a Collaborative Spirit Crosses competitive barriers Promotes a common vision by encouraging unique community-wide partnerships Outreach to under-immunized children Public/private collaboration designed to raise immunization rates

8. October 28, 2005Copyright @ 2005 Marshfield Clinic8 Wood County Intervention  75,555 total population (2000 U.S. Census Bureau)  100% provider participation  0-2 year old population  December 1999 67% UTD  February 2001 93% UTD  October 2005 92% UTD Objective: Raise immunization rates of 0-2 year olds to 95% UTD

9. October 28, 2005Copyright @ 2005 Marshfield Clinic9

10. October 28, 2005Copyright @ 2005 Marshfield Clinic10 Tiered Intervention Background  2001 task force of public/private providers met with a goal to develop countywide campaigns to raise immunization rates  Identified barriers to immunizations and developed methods to overcome them  Through RECIN, they developed an intervention process

11. October 28, 2005Copyright @ 2005 Marshfield Clinic11 Tiered Intervention Comprehensive reminder system involving all providers in a demographic area collaborating to raise immunization rates  Allows providers to track and document individual patient’s intervention history  Moves patients through an automated intervention process  Prevents duplication of notices/contacts  Automatic transition of non-compliant patients to Health Departments if desired

12. October 28, 2005Copyright @ 2005 Marshfield Clinic12 Tiered Intervention Method  Determine which immunizations and population to target  Set Goal  Assess population  Proactive vs. Overdue  Tiered vs. non-tiered approach  Identify age group to target  Set geographic parameters  Customize letters to fit individual practices  Begin intervention

13. October 28, 2005Copyright @ 2005 Marshfield Clinic13 Marathon County Intervention  125,834 total population (2000 U.S. Census Bureau)  12 immunization facilities in Marathon County – 100% participation  0-2 year old population  May 2001 – 81% UTD  May 2002 reached 93% UTD  November 2005 – 90% UTD

15. October 28, 2005Copyright @ 2005 Marshfield Clinic15 Marshfield Clinic FHC Results (patients 24-35 Months UTD) Communicate Results: Utilization of balanced scorecard Center20012005 Phillips74.193.8 Cadott66.7100 Colby/Abby84.9100 Athens33.3100 Chippewa Falls88.094.2 Marshfield Clinic85.791.1

16. October 28, 2005Copyright @ 2005 Marshfield Clinic16 Improving the Quality of Health Care: Lessons Learned  You need to first start  You need the right tool: – Increase provider participation – Facilitate community wide intervention efforts  Set a goal and communicate performance measures  Take what we’ve learned and expand to other regions  You need champions Goal: Protect patients from immunization preventable disease

17. October 28, 2005Copyright @ 2005 Marshfield Clinic17 Promotes Community Partnerships  Wisconsin Department of Health and Human Services  Local Health Departments  Private Providers  Schools  Daycare Facilities  Retirement Communities  Service Organizations  Parents/Patients

18. October 28, 2005Copyright @ 2005 Marshfield Clinic18 State and National Recognition 2001 Paul Harris Rotary Award  2002 National Immunization Registry Protect Award – Presented on behalf of the American Academy of Pediatrics and the National Immunization Program of the CDC  2002 Legislative Citation

19. October 28, 2005Copyright @ 2005 Marshfield Clinic19 In Summary The IOM Quality Chasm report says:  “The current care systems cannot do the job.”  “Trying harder will not work.”  “Changing care systems will.”