Online Program

Influenza vaccination rates among Medicaid recipients seeing primary care providers participating in a city-sponsored EHR subsidy program

Tuesday, November 5, 2013

Samantha De Leon, Phd, Primary Care Information Project (PCIP), NYC Department of Health & Mental Hygiene, Long Island City (Queens), NY
Sarah Shih, MPH, Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, NY
Winfred Wu, MD, Primary Care Information Project (PcIP), NYC Department of Health & Mental Hygiene, Long Island City (Queens), NY
Jason Wang, PhD, Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
The Primary Care Information Project (PCIP) is a quality improvement initiative targeting medical offices with high levels of Medicaid and uninsured patient populations and focusing on the delivery of preventive services by facilitating the implementation of an electronic health record that promotes preventive care and improvement of population health. Compare influenza vaccination rates among patients whose primary care providers are participating in PCIP to patients whose primary care providers are not. Using Medicaid claims data for Medicaid Managed Care (MMC) beneficiaries in New York City, influenza vaccination rates were compared between PCIP and non-PCIP primary care providers (i.e., family medicine, internal medicine, pediatrics, geriatrics, or preventive medicine), stratified by influenza season and patient demographics such as age, and the presence of medical conditions that can increase the risk of developing influenza-related complications. On average, ~2,000 PCIP providers treated ~940,000 and ~5,800 non-PCIP providers treated ~850,000 MMC patients per year. Mean vaccination rates were compared for groups of patients by clinician across three influenza seasons, at baseline (9/1/2008 – 4/30/2009) and end-of-study (9/1/2010 – 4/30/2011). From baseline, significantly larger increases (p-value <0.001) in influenza vaccination rates were observed among PCIP patients, particularly among those ≤ 18 years, i.e., ≤ 5 years [PCIP/baseline= 28.7% (percent increase= +6.2%); non-PCIP/ 23.1% (+3.9%)]; 6-12 years [PCIP/ 25.5% (+9.9%); non-PCIP/ 23.0% (+7.2%)]; 19-64 years [PCIP/ 13.5% (+3.7%); non-PCIP/ 11.6% (+1.7%)]; ≥ 65 years [PCIP/ 27.2% (+2.6%); non-PCIP/ 21.3 (+1.8%)]. Larger increases were also observed among those ≤ 18 with asthma [PCIP/ 12.8% (+1.5%); non-PCIP/ 8.0% (+0.3%)], and those ≥ 18 with diabetes [PCIP/ 14.8% (+1.3%); non-PCIP/ 12.3% (+0.2%)]. Results of this study suggest that a prevention-oriented focus to health care; namely, quality improvement initiatives utilizing health information technology can have a positive impact on preventive services utilization and potentially improve patient quality-of-care in medically under-served communities.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public

Learning Objectives:
List medical conditions and specific sub-populations that are at increased risk of developing influenza-related complications, and are therefore strongly urged to receive influenza vaccinations. Describe methods used in the electronic health record (EHR), and by the quality improvement/ EHR-subsidy program to improve influenza vaccination rates among primary care patients. Discuss the potential impact of a quality improvement/ EHR-subsidy program on influenza vaccination rates among primary care patients, particularly among sub-populations at risk of influenza-related complications.

Keyword(s): Clinical Prevention Services, Immunizations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have led several research studies on the interaction between health information technology and the impact on patient quality-of-care. My scientific interest is in the area of assessing the role of health information technology in improving preventive care delivery and population health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.