Measuring Practice Immunization Rates in the Era of HIPAA: A Study from PROS

Henry M Lemon, MD ¹, Eric J Slora, PhD ², Richard C Wasserman, MD ^2,5, Alison B Bocian, MS ², Herbert W Clegg, MD ³, David P Norton, MD ⁴ and Paul M Darden, MD ¹. ¹ Pediatrics and Cntr for Hlth Cre Rsrch, Med Univ of SC, Charleston, S.C.; ² Pediatric Research in Office Setings (PROS), Dept of Prac & Rsrch, Cntr for Chld Hlth Rsrch, Amer Acad of Pediatrics, Elk Grove Village, IL; ³ Charlotte, NC; ⁴ Baystate Med Center, Springfield, MA and ⁵ Univ of VT.

 

Background: Measuring practice-specific immunization rates has become more complicated under HIPAA.

 

Objective: To validate a new, HIPAA- compliant method for tracking immunization rates.

 

Design/Methods: Five practices in the AAPs practice-based research network, Pediatric Research in Office Setting Network (PROS), collected immunization data on 50 consecutive patients aged 8-35 months using two methods. The reference standard method used two trained research nurses independently examining photocopied patient Vaccine Administration Records with resolution of any disagreement. In the quick-count (QC) method, each office staff recorded counts of the number of patient vaccine doses without submitting patient identifiable information. Up-to-date immunization status (UTD) at 8 months of age was assessed for each patient. UTD was defined as 3 DTaP, 2 Hib, 2 Hep B and 2 Polio vaccines. Measures examined included kappa, sensitivity, specificity, positive predictive value, and negative predictive value.

 

Results: Both methods were used to assess 237 patients. The mean percentage of patients UTD by 8 months of age using the reference standard was 93%, (practice range 85%-98%). The mean percentage of patients UTD by the QC method was 92% (practice range 83%-98%). No significant difference was found between the methods in assessing an individuals UTD immunization status (McNemars test P>0.18). Agreement with the reference standard was excellent (Kappa = 0.85). QC was highly sensitive in determining up-to-date immunization status (99.5%) and had a specificity of 79%. QC had a positive predictive value for up-to-date immunizations of 98% and negative predictive value of 94%. A debriefing survey demonstrated that all practices found the QC data collection form easy to follow.

 

Conclusions: We found the QC method to be a valid, reliable, and HIPAA-compliant tool for assessing practice immunization rates. In this era of increased patient privacy concerns, this new method of efficiently extracting immunization information will be a valuable tool for research and quality improvement directed at improving immunization rates.