2003 Private Provider Immunization Assessments in Indiana

Immunization Index | Data and Statistics

Private Provider Immunization Assessments in Indiana

2003 Assessment Results

Indiana State Department of Health

Gregory A. Wilson, M.D., State Health Commissioner
M. Elizabeth Carroll, J.D., Deputy State Health Commissioner

Community and Family Health Services Commission

Wendy Gettelfinger, R.N., D.N.S., J.D., Assistant Commissioner

Immunization Program

Michael Runau, M.S., Program Director
Charlene Graves, M.D., Medical Director

Primary Author

Megan Steiger, M.P.H., Epidemiologist

Immunization Program
Indiana State Department of Health
2 North Meridian Street
Indianapolis, IN 46204
Publication Date: 06/2004

Preface

The Private Provider Assessments in Indiana report summarizes the results from 513 assessments of immunization practices completed in the private health care sector in Indiana for 2003. The assessments were conducted from January through December 2003 in private provider practices, including single and multiple physician practices enrolled in the Vaccines for Children (VFC) Program. Three sites not enrolled in the VFC program were given courtesy assessments requested by the private provider. In the 513 assessments, there were 25 sites that received more than one Clinical Assessment Software Application-based (CASA) assessment during the calendar year of 2003.

In order to be considered completely immunized by age two, each child must have received 4 vaccinations for diphtheria, tetanus, and acellular pertussis (DTaP), 3 vaccinations for polio, the first measles, mumps, and rubella vaccine (MMR), at least 3 vaccinations for Haemophilus influenzae type b (Hib), and 3 vaccinations for hepatitis B (HepB). The data contained in this report represents the immunization coverage levels of children who were 24 to 35 months of age at the time of the assessment.

Highlights

Five hundred thirteen private practices, composed of approximately 1070 individual practitioners, received a CASA-based assessment in 2003. Of those practices, 25 received 2 or more CASA-based immunization assessments during the assessment year of 2003.
An estimated 35,724 children aged 24-35 months were considered active patients of these providers at the time of the assessment.
Individual antigens and vaccine series completion levels for diphtheria, tetanus, and pertussis (DTaP); Polio; measles, mumps, and rubella (MMR); Haemophilus influenzae type b (Hib); and hepatitis B are presented in Table 2.
On the 4 DTaP: 3 Polio: 1 MMR: 3 Hib (4:3:1:3) vaccination series, 80.4% of two-year olds assessed were found to be up-to-date at 24 months of age. One hundred eighty-two (35.5%) of the providers had more than 90 percent of their children up-to-date on the 4:3:1:3 series by 24 months of age.
On the 4 DTaP: 3 Polio: 1 MMR: 3 Hib: 3 HepB (4:3:1:3:3) vaccination series, 78.4% of two-year olds assessed were found to be up-to-date at 24 months of age. One hundred sixty-four (32.0%) of the providers had more than 90 percent of their children up-to-date on the 4:3:1:3:3 series by 24 months of age.
A significant drop in coverage of 15.5 percent occurred between the first and final doses of the DTaP vaccine in private provider practices.

Summary Tables and Graphs

Table 1. Summary of private provider assessment results, Indiana, 2003.

Number of private providers assessed:	513
Number of physicians included in the assessments:	1,070
Number of counties where private provider CASA assessments were completed:	72
Number of two-year old children included in assessments:	11,292
Estimated number of two-year old children who are active patients in practices assessed:	35,724
Percent of these provider’s estimated two-year old patient population assessed:	31.6%

Table 2. Summary of individual antigen and vaccination series completion levels, by 24 months of age, private provider assessments (n=513), Indiana, 2003.

	Total % complete
INDIVIDUAL ANTIGENS
3 DTaP (Diphtheria, Tetanus, Pertussis)	98.0%
4 DTaP (Diphtheria, Tetanus, Pertussis)	83.8%
3 Polio (Oral and Inactivated)	93.0%
1 MMR (Measles, Mumps, and Rubella)	91.4%
3 Haemophilus influenzae type b (Hib)	96.4%
3 HepB (Hepatitis B)	94.1%
VACCINATION SERIES
4 DTaP: 3 Polio: 1 MMR	80.7%
4 DTaP: 3 Polio: 1 MMR: 3 Hib	80.4%
4 DTaP: 3 Polio: 1 MMR: 3 Hib: 3 HepB	78.4%

Table 3: Mean CASA assessment levels for private VFC provider sites in Indiana for assessment years 2000 through 2003.

Overall Two-Year Old Sample Coverage Levels
Series	2000	2001	2002	2003
4:3:1	69.6%	74.9%	79.6%	80.7%
4:3:1:3	68.6%	73.5%	79.2%	80.4%
4:3:1:3:3	65.8%	71.6%	76.7%	78.4%

Figure 1: Mean Private Provider 4:3:1, 4:3:1:3 and 4:3:1:3:3 coverage levels for assessment years 2000 (n=438), 2001 (n=499*) 2002 (n=538), and 2003 (n=513**) assessments.

*Includes 3 CASAs using hybrid method (unable to do statistical analysis on this methodology, therefore, not included in these statistics).
**Includes 3 CASAs completed at non-VFC provider sites

Figure 2: 4 DTaP: 3 Polio: 1 MMR: 3 Hib coverage levels at 24 months of age, private provider assessments, Indiana, 2002 (n=538) and 2003 (n=513).

Figure 3: 4 DTaP: 3 Polio: 1 MMR: 3 Hib: 3 HepB coverage levels at 24 months of age, private provider assessments, Indiana, 2002 (n=538) and 2003 (n=513).

Table 4. Drop in coverage for DTaP vaccination series by median and mean percentages, private provider assessments (n=513), Indiana, 2003.

	Median % drop	Mean % drop
Drop in coverage between the first DTaP by 12 months of age and the fourth DTaP by 24 months of age	12.5%	15.5%

Figure 4: Median and mean percent coverage levels of successive DTaP vaccinations, private provider assessments (n=513), Indiana, 2003.

Recommendations and Conclusions

Immunization rates in private providers have gradually increased over the past four assessment years. Private providers should continue their efforts to improve the health status of children in Indiana through all available means which include good immunization practices.
More private providers have shifted to the 90 percent or greater immunization coverage rate on the 4:3:1:3 and 4:3:1:3:3 immunization series. Providers falling above 90 percent coverage rates have provided a good example of strong immunization practices.
Large decreases in immunization coverage levels continue to occur between the third and fourth doses of DTaP. Private providers need to improve their practices to ensure patients receive all recommended doses of a vaccine.
There is not a significant difference between the median and mean coverage levels in regard to the DTaP vaccination series. Therefore, both measures provide an accurate representation of DTaP vaccination rates for this report.
Providers need to remain up-to-date on ACIP recommendations in regard to the childhood immunization schedule. VFC providers are notified by the Immunization Program (i.e. through informational updates) when updates have been made to the schedule. A current copy of the Recommended Childhood Immunization Schedule is available through the VFC program or can be accessed on the Immunization Program website (http://in.gov/isdh/programs/immunization.htm).
In future assessment years, the Immunization program will be looking at the 4 DTaP: 3 Polio: 1 MMR: 3 Hib:3 Hep B immunization series as a standard of measurement. Public providers should focus on improving their rates for this series.