When the Law Fails, Try Humor and Bribery Obtaining Clean Data

1. When the Law Fails, Try Humor and BriberyObtaining Clean Data The CT Immunization Registry and Tracking System (CIRTS) The State of CT Department of Public Health Joan Christison-Lagay, CIRTS Consultant Michael Tommasi, CT DPH Nancy Caruk, CT DPH

2. An Art, Not a Science Obtaining clean data is an art, not a science. Many approaches must be used. In l994, CT passed legislation requiring pediatric and family practices to submit immunization histories to the State DPH. Despite the legislative mandate, not all practices reported in a timely fashion. A few failed to report at all. The law alone was insufficient.

3. Humor Initial monthly letters were factual and dry; staff suspected that many went unread. Monthly letters now begin with humor. Examples (these from middle school science exams): • Three kinds of blood vessels are arteries, vanes and caterpillars • The body consists of three parts: the brainium, the borax and the abominable cavity. The brainium contains the brain, the borax contains the heart and lungs, and the abominable cavity contains the bowels, of which there are five: a,e,i, o and u.

4. Bribery • A “Pediatric Practice of the Week” coffee cake award was institutedin different categories; e.g., “for consistent & on-time reporting” • Cheap! Only $25/week or $1300/year which is much less than brochures • Great response from office staff; “I’m drooling,” & “how can we win?”

5. Persistence Despite the law, humor and bribery, a few practices still fail to submit monthly data. CIRTS seeks out missing reports through persistent phone calls. The monthly report is not complete until all 469 public and private practices in CT have submitted data. Nineteen IAP coordinators statewide help track reports and children.

6. De-duplication De-duplication remains a time-consuming problem which has not been perfected by CIRTS. Last names on automatic feeds such as birth certificates and Medicaid files often do not match. To address this, CIRTS runs reports that look for children with the same first name and date of birth.

7. A Last Chance At the end of every calendar year • Medicaid Plans are sent a list of their children with no or few visits to the PCP on record. Plans check claims and provide CIRTS the latest PCP. • All practices receive a report specifying which immunizations are missing on individual children. Practices have one month to submit clean-up data.

8. The Results of CIRTS’Efforts = Clean Data • CIRTS has enrolled more than 80% of all CT newborns since l999 • CIRTS obtained immunizations other than Hep 1 on 80% of all children born in 2000 • DATA are complete and clean enough to run: • HEDIS reports for all 2 year old Medicaid children • Immunization status reports for all practices in CT • Special reports; e.g., effects of DTaP shortage

9. Comparison of CT Registry Data and NIS Data CIRTS Children Born Jan-Dec 2000* Immunization rates * 89.5% of birth cohort excluding moved, deceased, adopted & refusals

10. Special Reporting CapabilityExample: Inferences Drawn on Possible Effect of DTaP Shortage--Rates With & Without a 6 Month Grace Period* *Preliminary data

11. Challenges to Meet • 42,659 children were born in CT in 2000 • 1,737 (4.1%) moved, died or were adopted by age 2 • 40,922 were potential enrollees at age 2 but only 34,111 (83.4%) were enrolled. Non-enrollees included refusals and those on whom no enrollment form was received.

12. Challenges to Meet • 2,783 (7.2%) of 38,519 parents elected to opt-out • 4,028 (9.5%) of parents submitted no form. CIRTS was unsure if they had received a form or not. Challenges to CIRTS • work with providers to convince parents to rescind the refusal given at birth • ensure that all parents receive an enrollment form, perhaps through a mailing. This would enable CT to exercise its “opt-out” law.