Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.8 Vaccine-Preventable Diseases
A.8 Vaccine-Preventable Diseases
Pages 324-344
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From page 324... ...
Immunization targets set by Healthy People 2000 (USDHHS, 1991) call for 90 percent of 2-year-old children to have received all recommended vaccine doses and for 60 percent of persons aged 65 and over to have received a pneumococcal vaccination and an annual influenza vaccination.
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From page 325... ...
The recognition that incomplete immunization poses an avoidable health risk has prompted a variety of efforts at national, state, and local levels to raise immunization rates. Activities include establishing collaborations that can promote responsibility and accountability for immunization, improving provider practices and communication with the public, and developing better information resources.
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From page 326... ...
In the United States, from 20,000 to 40,000 influenza-associated deaths have occurred annually during recent epidemics (CDC, 1995b) , and excess hospitalizations have been estimated to reach 172,000 during severe epidemics (Barker, 1986)
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From page 327... ...
An indicator for the influenza immunization rate among the population that is at higher risk is included in the following section. Individual Behavior, Social Environment, Health Care Because vaccines effectively prevent disease, immunization rates can seen as both a process measure and a meaningful proxy for health outcomes.
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From page 328... ...
Obtaining the data needed to calculate immunization rates -- immunization status of individuals at specific ages and size of the population at those ages -- may pose a challenge for communities. Retrospective rates can be calculated when children enter school, but these rates do not reflect current immunization levels among 2-year-olds.
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From page 329... ...
Even though Medicare benefits include coverage for both of the above immunizations, immunization rates remain low. Medicare claims files might be a source of data for this indicator, but they will not reflect immunizations provided in settings in which fee-for-service claims are not generally submitted (e.g., hospitals,
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From page 330... ...
Medicare coverage for influenza immunizations was not available until 1993. Lack of easy access to current information on the immunization status of children in a community has spurred interest in state or local immunization registry systems.
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From page 331... ...
5. Existence in the community of a computerized immunization registry that provides automated appointment reminders; if a registry exists, percentage of children in the community included.
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From page 332... ...
play a large part in determining immunization rates in a community. Missed opportunities to administer immunizations could be reduced by steps such as reviewing immunization status at all visits, giving all scheduled vaccines during a visit, and vaccinating during visits for mild illnesses.
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From page 333... ...
Currently, many providers lack automated information systems that can generate information on the immunization status of their patients. Regular chart audits are one way to identify patients whose immunizations are not up to date.
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From page 334... ...
Immunization registries are expensive, but other than periodic chart review on a community-wide basis, they are the only way to make the regular assessments of current immunization status that can inform efforts to improve immunization rates and health status. One of the indicators may require cooperation from employers to obtain necessary data.
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From page 335... ...
2. Immunization rate at 24 months of age for children currently enrolled in managed care organizations.
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From page 336... ...
4. Existence in the community of a computerized immunization registry that provides automated appointment reminders; if a registry exists, the percentage of children in the community included.
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From page 337... ...
These data may understate immunization rates if a large percentage of Medicare enrollees in the community are enrolled in capitated managed care plans that do not file claims for the individual services provided or are vaccinated as
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From page 338... ...
, risk factors (immunization coverage rates for all children, children in managed care organizations, Medicaid children, Medicare enrollees) , and community actions that can help to improve immunization coverage
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From page 339... ...
In terms of performance, the indicator for immunization coverage rates for all children covers the community as a whole. Three other measures (children in managed care organizations, Medicaid children, Medicare enrollees)
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From page 340... ...
1995. Population Health Surveillance in a Managed Care Setting: A Con tinuous Quality Improvement Project to Increase Pediatric Immunization Rates Using Administrative Claims and Survey Data.
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From page 341... ...
1996. The Impact of the Standards for Pediatric Immunization Practices on Vaccination Coverage Levels.
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From page 342... ...
TABLE A.8-1 Field Model Mapping for Sample Indicator Set: Vaccine-Preventable Diseases 342 Field Model Domain Construct Sample Indicators Data Sources Stakeholders Disease Eliminate vaccine- Pneumonia and influenza Death certificates Health care providers preventable diseases death rates for persons age Health care plans 65 and older State health agencies Local health agencies Business, industry Community organizations Special health risk groups General public Individual Ensure that Medicare Percentage of Medicare Immunization Health care providers Response enrollees are enrollees who received an registry or Health care plans immunized appropriately influenza immunization medical charts State health agencies during the previous year; Local health agencies percentage who have ever Community organizations received a pneumococcal Special health risk groups pneumonia immunization General public Ensure that children Immunization rate for are immunized children at 24 months of age appropriately Social Ensure that Immunization rate at Immunization Health care providers Environment populations with 24 months of age for registry or State health agencies special health risks children currently enrolled medical charts Local health agencies are immunized in Medicaid Special health risk groups appropriately IMPROVING HEALTH IN THE COMMUNITY
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From page 343... ...
Reduce financial Among children with Employers, Health care plans barriers to commercial health insurance, insurance Local government immunization percentage with full coverage licensing Business, industry for immunization authority General public Provide leadership for Existence in the community Health care providers immunization efforts of an active childhood Health care plans immunization coalition State health agencies Local health agencies Local government Business, industry Education agencies and institutions Community organizations A.8 VACCINE-PREVENTABLE DISEASES Special health risk groups General public Health Care Ensure that the health Immunization rate for children Immunization Health care providers care system is organized at 24 months of age registry or Health care plans to provide high medical charts State health agencies immunization rates Local health agencies Business and industry Community organizations Special health risk groups General public Immunization rate at 24 Immunization Health care providers months of age for children registry or Health care plans currently enrolled in medical charts Business and industry managed care organizations General public continued on next page 343
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From page 344... ...
TABLE A.8-1 Continued 344 Field Model Domain Construct Sample Indicators Data Sources Stakeholders Health Existence in the community of Immunization Health care providers Care a computerized immunization registry, Health care plans (continued) registry; if available, birth records State health agencies percentage of children Local health agencies in the community General public included Ensure that Medicare Percentage of Medicare enrollees are enrollees who received an immunized appropriately influenza immunization during the previous year; percentage who have ever received a pneumococcal pneumonia immunization IMPROVING HEALTH IN THE COMMUNITY
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