1. RECIN Intervention- Collaborating to Raise Immunization Rates Jeannie Tichy RECIN Immunization Registry Marshfield Clinic Marshfield, Wisconsin

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

3. Copyright 2002 3 RECIN Background Web based, “live” 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 use to record and assess the immunization status of shared patients Used for childhood and adult immunization tracking First deployed in 1995

4. Copyright 2002 4 Identifying Children who are Overdue for Immunizations Set a goal Assessment –Can be county/city 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 5 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 6 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 Passed on to Health Department Facility Population Complied? Yes Complied? No Complied? Yes Complied? No Complied? No Complied? Yes

8. Copyright 2002 8 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 9 Health Department’s Responsibilities Health Departments are responsible for assuring proper immunization coverage for residents in their county –Collaborating HD’s run intervention on: Patients where they are the last immunization provider on 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 10 What makes Tiered Intervention Work? Rule 1: The last immunization provider on record is assigned the intervention responsibility for the patient.

11. Copyright 2002 11 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 12 Rule 3: No facility conducts intervention on a patient who has a history of tiered intervention in the past 6 weeks by a different facility. Prevents multiple letters When intervention efforts are exhausted, patient is able to be picked up by county 6 weeks after last intervention effort

13. Copyright 2002 13 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 14 Think in Multiple Dimensions Facilities have simultaneous multiple campaigns (early childhood, adult Td, kindergarten roundup …) Multiple facilities are running various campaigns on overlapping populations Patients are moving between facilities Not all facilities are doing intervention

15. Copyright 2002 15 Marathon County Intervention First county to test tiered intervention 12 immunization providers in the county Started in May, 2001 with immunization rate of 81% UTD (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% UTD –4382 total patients, 323 overdue

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

18. Copyright 2002 18 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 19 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! Jeannie Tichy Marshfield Clinic tichy.jean@marshfieldclinic.org 715.221.8165