Keith S, Momin S, King A, Momin S, Slagle J; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 28.
BlueCross BlueShield of Tennessee, 801 Pine Street, 2G, Chattanooga, TN 37402-2555; Tel: 423-752-7603; Fax: 423-763-3248; E-mail: Sheila_Keith@BCBST.Com
RESEARCH OBJECTIVE: The primary objective of this study was to demonstrate the true immunization rate using an integrated data collection approach. STUDY DESIGN: A Microsoft Access database was populated with all HMO/POS children who turned two years of age by 12/31/00, and who were continuously enrolled with no more than a 45 day break in enrollment. Immunization information for the study population was added to database from paid claims data, Tennessee Department of Health's State Immunization Registry data, and medical record data from primary care physicians (PCPs), health departments and hospitals. Member-specific data collection tools were populated and hand delivered to the assigned PCP or PCP's office staff. For members with missing information, a $10 gift certificate was offered to the PCP office for each completed form. Aggressive follow-up resulted in 100% response rate from PCPs. This enabled the removal of data fragmentation by aggregating all data into one combined database, and stratification of all children still missing data into one of the four categories for further analysis and action. Since it was determined that many times the first Hepatitis B was given in the hospital, data were also collected from the hospital where the child was born. Additionally, telephonic outreach continued with state health departments and member's parents in an attempt to locate all missing data. When coding errors were identified, PCPs were educated on the correct codes for immunization. The database was continuously monitored for data anomalies, which were shared with the operational areas so that information systems could be updated. POPULATION STUDIED: The study group consisted of 1,005 commercially insured children of managed care plans (HMO, POS) administered by a MCO in the Southeastern US. PRINCIPAL FINDINGS: We were able to achieve HEDIS 2001 immunization rate of 67.8% compared to 46.7% in 2000. The relaxed HEDIS rate increased from 53.8% to 88.7%. The remaining 11.3% (112) children who were not fully immunized were stratified into four distinct categories: (1) Parents were unaware that immunization were incomplete (74%), (2) Parents aware (6%), (3) Could not verify with parent (14%), and (4) Could not verify with provider (6%). CONCLUSIONS: BlueCross BlueShield of Tennessee was confronted with low reported childhood immunization rates for two years despite aggressive communication campaigns to practitioners and members, a state immunization registry, and an excellent HMO benefit for preventive services for children. We were unable to demonstrate improvement in childhood immunization rates from any single source. The data were fragmented due to members frequently changing physicians and health plans, physicians referring members to local health departments to obtain immunization, and multiple other data anomalies. Our strategy to aggregate the data from multiple, unrelated sources helped us demonstrate the true immunization rate. The study results also indicated that; (a) providers' response is higher with face to face communication than mailed correspondence, and (b) members do not understand specifics of benefits and often only authorize preventive services if the provider tells them it is a covered benefit. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: 1. Integrated data collection approach represents a cost effective and innovative quality improvement in childhood immunization data collection. 2. The same approach can be replicated in other populations (e.g. Medicaid) and hybrid HEDIS measures. PRIMARY FUNDING SOURCE: BlueCross BlueShield of Tennessee
Publication Types:
Keywords:
- Child
- Child Health Services
- Health Maintenance Organizations
- Humans
- Immunization
- Immunization Programs
- Managed Care Programs
- Medicaid
- Parents
- Physicians, Family
- Postal Service
- Registries
- Research Design
- Tennessee
- Vaccination
- economics
- methods
- hsrmtgs
Other ID:
UI: 102274233
From Meeting Abstracts