Using an immunization information system to improve accountability for vaccines distributed through the Vaccines for Children Program in New York City, 2005-2008

Background: As new, higher-priced vaccines are added to the immunization schedule, Vaccines for Children (VFC) program costs are increasing and attention has been focused on strengthening accountability. In New York City, the VFC program provides publicly purchased vaccines, worth nearly $117 million, to over 1,500 enrolled facilities annually to immunize eligible children. In 2006, we changed our policy of requiring self-reported, aggregate doses administered reports from VFC facilities to account for VFC vaccine administration to requiring reports generated from our immunization information system (IIS), the Citywide Immunization Registry (CIR). Reporting to the CIR of immunizations administered to children has been mandatory for NYC providers since 1997.

Objectives: To improve VFC accountability and increase CIR reporting by linking VFC vaccine ordering by each facility to the facility's reporting of doses administered to the CIR.

Methods: We matched all VFC facilities to those in CIR. Using CIR and VFC data, we calculated a CIR-generated DAR percentage for each facility by dividing doses reported as administered to eligible children by VFC doses distributed to the facility. We informed facilities that their CIR-generated DAR must be > 90% or their vaccine orders might be reduced.

Results: After the change, CIR reporting for children < 8 years increased 71% and the percentage of doses distributed that were reported as administered to eligible children increased from 40% to 67%. Few VFC facilities protested and none dropped out of VFC.

Conclusions: Transitioning from reliance on self-reported DARs to IIS-generated DARs improved VFC accountability and increased IIS reporting and data completeness. This approach may be adopted by immunization programs nationwide to achieve these objectives.