Identification and Recall of Children With Chronic Medical Conditions for Influenza Vaccination

Abstract

ABSTRACT. Objectives. Despite long-standing recommendations to provide annual influenza vaccination to children with chronic medical conditions, immunization rates are <10% in most primary care settings. Many obstacles impede implementation of these recommendations, including the challenge of identifying targeted children and the need to immunize yearly in a short time interval. The objective of this study was to assess the accuracy of billing data for identifying children who have high-risk conditions (HRCs) and need influenza vaccination and 2) to evaluate the efficacy of reminder/ recall for children with HRCs.Methods. The study was conducted in 4 private pediatric practices in metropolitan Denver, Colorado, that share a computerized billing system and also participate in an immunization registry. For all children aged 6 to 72 months, registry records were linked with the billing database. Patients with >1 encounters for an HRC in the previous 24 months were selected, with HRCs identified from International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Using medical records as the "gold standard," we reviewed 327 randomly selected records to determine the sensitivity, specificity, and accuracy of billing data for identifying HRCs. For children with an HRC, we then conducted a randomized, controlled trial of reminder/recall for influenza vaccination. The primary outcome of the recall trial was receipt of influenza vaccine.Results. Billing data had a sensitivity of 72% (95% confidence interval [CI]: 48%-95%), specificity of 95% (95% CI: 90%-100%), and overall accuracy of 90% (95% CI: 84%-96%) in determining which children had an HRC. Of the 17 273 patients aged 6 to 72 months, 2007 had >1 HRCs (12% overall; range: 9%-14% per practice). Asthma/reactive airways disease accounted for 87% of all HRCs. Reminder/recall significantly increased influenza immunization in children with HRCs, with a vaccination rate of 42% in those recalled, compared with 25% in control subjects. Recalled subjects were more likely to have an office visit (68% vs 60%) and less likely to have a missed opportunity to immunize (28% vs 37%) compared with control subjects.Conclusions. Diagnosis-based billing data accurately identified children who had HRCs and needed annual influenza vaccination, and registry-driven reminder/recall significantly increased influenza immunization in targeted children. T he influenza viruses place a significant health burden on the US population, causing an average of 34 000 deaths and 114 000 influenzarelated hospitalizations nationally each winter. 1,2 Young children, older adults, and individuals of any age with certain chronic medical conditions are particularly at risk for complications, hospitalizations, and death during annual influenza epidemics. [3][4][5][6][7] In a retrospective study of 20 years of Tennessee Medicaid enrollees, children with high-risk conditions (HRCs) were 2 to 4 times more likely to have an influenza-associated hospitalization than were healthy ch...

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

“…Previous studies have examined interventions to improve influenza vaccination in children, [10][11][12][13][14] but this study is the first, to our knowledge, to simultaneously assess practice and child characteristics and practice strategies associated with influenza vaccination coverage in geographically diverse sites. We found that two modifiable factors were associated with increased complete influenza vaccinations--any practice visit during October through January and evening/weekend influenza vaccine clinics.…”

“…From this framework, we selected relevant factors from the literature and immunization strategies recommended by this Task Force. [10][11][12][13][14]19 The survey was pilot tested in a convenience sample of pediatric providers and their office managers. The self-administered survey included 22-items concentrating on practice patterns for administering vaccine to children aged 6-23 months.…”

“…9 Most studies evaluating methods to increase vaccination rates in young children were reported prior to the universal influenza vaccination recommendations for young children. [10][11][12][13][14] Since the majority of childhood vaccines are administered in primary care settings, 15 we sought to determine both practice and child characteristics and practice strategies that were associated with influenza vaccine coverage among children aged 6-23 months in [2004][2005], the first season that influenza vaccine was universally recommended.…”

Adherencia a las inmunizaciones en niños con necesidades de cuidado médico especial

“…Otros estudios en población de niños con enfermedades crónicas han mostrado que sólo 17 a 25% reciben vacuna antigripal 29 .…”

“…Para mejorar la adherencia a la vacunación en niños con NECMES se requiere incorporar registros computacionales 16,18,19 con acceso a información en forma confiable, expedita y transversal, entre centros de atención primaria y terciaria, que incluya, además, sistemas de recordatorio o aviso automáticos para los padres y encargados de vacunación [27][28][29] .…”