Improving Childhood Immunization Rates in Maine Amy Belisle, MD, - PowerPoint PPT Presentation

Improving Childhood Immunization Rates in Maine Amy Belisle, MD, Maine Quality Counts Cassandra Cote Grantham, MA, MaineHealth Caroline Zimmerman, MPP, Maine Primary Care Association/Maine Immunization Coalition

Agenda • Setting the Stage – What does the data say? • Landscape of Childhood Immunizations Efforts in Maine – Improving Health Outcomes for Children (IHOC) and First STEPS – MaineHealth and the Childhood Immunizations Taskforce – Maine Immunization Coalition • Discussion and Questions

National Immunization Survey (NIS) Target Population: 19-35 month olds living in the U.S. (also • data for the adolescent population) • Estimated rates of being up-to-date on all childhood vaccinations recommended by Advisory Committee on Immunization Practices • Up-to-date estimates based on two data sources − Parents- random-digit-dialing telephone survey (year-round; does include cell #s) − Health Care Providers • Parents of NIS-eligible children are asked for permission to contact child’s medical provider • If consent provided, provider sent questionnaire • Rates reported are based on comparison of the two sources

NIS: More About Estimates • NIS interviews a sample from each state; NOT the entire population • Every sample’s point estimate is likely different than the total population’s true rate − Therefore, a 95% confidence interval is calculated for each sample estimate − We can be 95% confident that the true rate for the entire population IS in the range (i.e. interval) • Example: 2010 Up-to-Date (UTD) rate for the series 4:3:1:3:3:1:4 − Maine’s estimated UTD rate was 67.0 ± 7.5% (from NIS) − Maine’s true UTD rate for the entire population of 19-35 mth olds • was NOT likely=67%, but • WAS LIKELY to be between 59.5% and 74.5% • If the confidence intervals for two estimates overlap, the observed difference in the point estimates might be due to chance (Cannot say that there really a difference in the population rates.)

How Maine Compares to the U.S. (2013 NIS Data released in 2014) Percent of 19- to 35-Month-Olds Up-to-Date for a Series of Seven Immunizations 2016 MaineHealth target: 82% or more Best State: Rhode Island 82% See notes below 69% U.S. 70% 67% Maine 68% 67% 44% 38% 29% 2007 2008 2009 2010 2011 2012 2013 1: In response to a national shortage of Haemophilus Influenza B vaccine in 2009, clinicians were encouraged to delay booster shots. These delays reduced Up-to-Date rates for the series graphed above. 2:In 2009, the National Immunization Survey began reporting a measure that more accurately estimated the true Up- to-Date rate in each state. These more accurate estimates (lines from 2009-2013) are not directly comparable to the older measure’s rates in 2007-2009.

100 10 20 30 40 50 60 70 80 90 0 Green band shows that Maine’s confidence interval overlaps with nearly all other states Blue Bars = 95% Confidence Intervals for State Estimates Rhode Island Seven Immunizations – All US States Estimated Percent of 19-35 Month Olds Up-to-date for Series of 2013 National Immunization Survey: Nebraska Massachusetts Iowa Connecticut Alabama Dist. of… Maryland Pennsylvania Utah New… Mississippi Minnesota South Dakota New Jersey Wisconsin Kentucky Texas New York North Carolina North Dakota Delaware Washington US National • Idaho Florida Michigan Wyoming Georgia California Colorado Virginia Louisiana Kansas Indiana Tennessee Maine Missouri Vermont Illinois Oregon Hawaii South Carolina New Mexico West Virginia Montana Arizona Alaska Oklahoma Ohio

100 10 20 30 40 50 60 70 80 90 0 Mississippi *States not listed did not report South Dakota South Carolina Alaska Arkansas (bars=95% Confidence Intervals for state estimates) Percent of children who received ≥1 dose Td/Tdap since age 10 yrs 2013 Estimates – NIS – All US States* West Virginia Iowa Oklahoma Hawaii Idaho Missouri Georgia Maine Tennessee Maine Virginia Maryland Kansas Ohio Montana Dist. of Columbia Delaware Florida Kentucky Louisiana Utah Arizona Oregon Michigan Nebraska US National New Mexico Nevada Illinois Texas interval for Maine up to date rate Band represents confidence Colorado New Jersey Alabama Washington California North Carolina Indiana Connecticut New York Pennsylvania Vermont Minnesota Wyoming Rhode Island Wisconsin North Dakota Massachusetts New Hampshire

100 10 20 30 40 50 60 70 80 90 0 Arkansas *States not listed did not report Mississippi Montana South Dakota Alaska conjugate vaccine – All US States* Percent of children who received ≥1 dose of meningococcal 2013 Estimates- National Immunization Survey Data Kansas Missouri Utah (bars=95% Confidence Intervals for state estimates) Wyoming Iowa Nevada Virginia Oregon Oklahoma Minnesota Tennessee South Carolina Ohio Alabama New Mexico Kentucky Maine Maine Idaho Florida North Carolina Colorado Hawaii Georgia West Virginia Nebraska US National Maryland Illinois interval for Maine up to date rate Band represents confidence Washington Vermont California Wisconsin Delaware New York New Hampshire Arizona Texas Louisiana Massachusetts Pennsylvania Connecticut Michigan Dist. of Columbia New Jersey Rhode Island Indiana North Dakota

100 10 20 30 40 50 60 70 80 90 0 Utah *States not listed did not report Kansas Arkansas Mississippi Kentucky (bars=95% Confidence Intervals for state estimates) Percent of 13-17 Year-Old Females Who Had Full HPV Series (≥3) – 2013 Estimates – NIS – All US States* Alaska Nevada Virginia Montana Missouri Dist. of Columbia Idaho New Jersey North Carolina Georgia Maryland Illinois Florida Hawaii Michigan Indiana Ohio Oklahoma Tennessee Wisconsin Arizona US National Minnesota West Virginia Texas Colorado Massachusetts Oregon interval for Maine up to date rate Band represents confidence Alabama Connecticut South Carolina North Dakota Nebraska Iowa Louisiana Wyoming South Dakota Vermont New Hampshire New Mexico Washington New York California Maine Maine Pennsylvania Delaware Rhode Island

100 10 20 30 40 50 60 70 80 90 0 *States not listed did not report Utah interval for Maine up to date rate Band represents confidence Michigan Mississippi Nevada Series, among those who had at least 1 dose* Percent of 13-17 Year-Old Females Who Had Full HPV 2013 Estimates- NIS North Carolina Arkansas Idaho (bars=95% Confidence Intervals for state estimates) Kansas Alaska Arizona Dist. of… Kentucky Missouri Georgia Montana Wisconsin Oregon Virginia New Hampshire Nebraska Oklahoma Illinois Ohio New Mexico Minnesota Hawaii US National Colorado Indiana California Maryland South Carolina New Jersey Alabama Massachusetts Texas Louisiana Tennessee Connecticut North Dakota Rhode Island New York Florida Vermont South Dakota Washington Maine Maine West Virginia Iowa Delaware Wyoming Pennsylvania

10 15 20 25 30 0 5 *States not listed did not report Nevada Michigan interval for Maine up to date rate Band represents confidence (bars=95% Confidence Intervals for state estimates) Percent of 13-17 Year- Old Males Who Had Full HPV Series (≥3) 2013 Estimates – NIS – All US States* Indiana South Dakota Wyoming Alaska Minnesota Montana Colorado Oregon North Carolina Washington Florida Louisiana Iowa Wisconsin US National New Jersey Ohio Texas Hawaii West Virginia Georgia Pennsylvania Illinois California Oklahoma Maine Maine New Hampshire Delaware North Dakota New York New Mexico Arizona Nebraska Vermont Massachusetts Connecticut Dist. of Columbia Rhode Island

2013 Estimates – NIS – All US States* Percent of 13-17 Year-Old Males Who Had Full HPV Series, among those who had at least 1 dose 100 (bars=95% Confidence Intervals for state estimates) 90 80 Maine 70 60 50 40 30 20 Band represents confidence 10 interval for Maine up to date rate 0 Dist. of… Michigan Nevada Tennessee California Colorado Maryland Georgia North Carolina Pennsylvania Oregon Oklahoma South Dakota Alaska Hawaii Maine Texas US National Montana Minnesota Washington Connecticut New Jersey Iowa New Hampshire Arizona Illinois Louisiana Nebraska Florida New York Delaware New Mexico Wisconsin Massachusetts Vermont Ohio North Dakota West Virginia Rhode Island *States not listed did not report

In 2014, we are monitoring population- based immunization rates from different sources, using different metrics – CONFUSING! • NIS/America’s Health Rankings: – Maine’s 2 year old immunization rate increased from 69% in 2011 to 72.6% in 2012, and decreased to 68% in 2013 – Adolescent immunizations (13-17 year old) rate increased from 59.5% to 65% in 2012 and to 66.7% in 2013 – Maine CDC (Sept. 2014) - 4 national CDC awards (2 adult; 2 kids) - increase in toddler rates by 35 months and childhood flu vaccine • Maine Immunization Program – AFIX visits (2 yr olds UTD at age 35 months; 4.3.1.3.3.1.4) • Improving Health Outcomes for Children (IHOC)/CHIPRA metrics – from ImmPact by practice; no national benchmarks; gold standard

IHOC/CHIPRA Measures • Immunizations up-to-date at age 2 years (includes Hep A, Rotavirus and Flu) • Immunizations up-to-date at age 6 years (MMR, VAR, DTaP and IPV) • Immunizations up-to-date at age 13 years (HPV, MCV and Tdap)