Improving the Accuracy of Immunization Rate Data

Danette Glassy, MD, FAAP

I am a primary care pediatrician, trained in one of the best residency programs in the country and inspired by great, too-many-to-mention community pediatricians practicing primary care.  So of course our practice does all we can to ensure our patients are fully immunized.  From keeping an appropriate supply of perfectly refrigerated/frozen stock, to asking about catch-up at nearly every visit, to running an impressive mass vaccination during flu shot season.  We even cultivate our relationship with the vaccine-hesitant parents to slowly, fully immunize their children.

Surprisingly, when our vaccination rates were calculated by the state vaccine registry, or even our own internal EMR reports, it was not nearly as high as we expected.  Our “denominator” was off.  Patients who were no longer “ours” were increasing the pool that our percentages were calculated from, lowering our percent vaccinated.  As entirely infuriating as it is that pediatric practices are judged on these numbers (and someday compensated for), it is a reality.

We looked inward first.  What was our policy for inactivating patients within our EMR?  How about all the patients that have aged out of pediatric practice over the decades? Who will do all of this work to inactivate?

Next, we took on the state registry.  How can we reduce the number of patients attributed to us that have moved (especially out of state) or grown up?  How can we even begin to afford the manpower to fix these various collections of data?

It takes a village:  as a member of the WCAAP program Pediatric Transforming Clinical Practice Initiative (P-TCPI), we have a coach who offered her time for an improvement project.  P-TCPI practice facilitator Christine Stalie came into our office multiple days for hours at a time and inactivated patients who had not been seen for 3 years or more and were too old for our practice.  We ran a report of all kids not seen in the last 3 years and contacted them to confirm they were still “with” us and remind them to come for a well check.

Our vaccine manager worked with the Department of Health to come up with a streamlined way to clean up the patients attributed to us in the Washington State Immunization Information System (registry).

Is the data now correct?  Absolutely not.  It never will be, and we will continue to measure on this inaccurate data.  But we were able to improve it and use people who are also committed to making our numbers as accurate as possible.