Using Administrative Claims to Identify Children With Chronic Conditions in a Statewide Immunization Registry | Page 4
Published Online: May 20, 2014
Kevin J. Dombkowski, DrPH, MS; Lauren Costello, MSW; Shiming Dong, MS; and Sarah J. Clark, MPH
Our findings should be considered in light of several limitations. We were unable to evaluate the accuracy and completeness of the commercial healthcare claims data used to populate the high risk indicator in MCIR. Consequently, we were therefore unable to verify the accuracy of using the administrative claims data from the commercial health plans in identifying children with chronic conditions. Additionally, although this study examined missed opportunities among children with chronic conditions, we are unable to determine why missed opportunities occur. Furthermore, because our study intended to demonstrate the feasibility of using administrative data to identify children with chronic conditions, children were included in our sample if they had at least 1 claim for a chronic condition regardless of the number of provider encounters, severity, or duration of the condition. Future studies examining the accuracy, feasibility, and utility of using administrative claims data should also take into account the severity of chronic condition by subdividing children with chronic conditions into complexity groups. Finally, it should be noted that substantial time lags were encountered with respect to executing the data-use agreements required for this study. Such delays should be considered in future studies or applications of these methods to public health practice.
In conclusion, our study found that administrative claims data can be used to identify children with chronic conditions in a statewide registry. Low vaccination rates and a high rate of missed opportunities among the children with chronic conditions in our sample suggests the utility of integrating administrative claims data with statewide registries for use of various outreach strategies, including reminder/recall aimed at parents and provider-focused reminders.
Author Affiliations: Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI (KJD, LC, SD, SJC).
Source of Funding: This study was supported by the Center for Healthcare Research and Transformation.
Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (KJD, SJC); acquisition of data (KJD, SD); analysis and interpretation of data (KJD, LC, SD, SJC); drafting of the manuscript (KJD, LC); critical revision of the manuscript for important intellectual content (LC, SJC); statistical analysis (KJD, SD); obtaining funding (KJD); administrative, technical, or logistic support (SJC); supervision (KJD).
Address correspondence to: Kevin J. Dombkowski, DrPH, MS, University of Michigan, Division of General Pediatrics, 300 N Ingalls, Rm 6D05, Ann Arbor, MI 48109-5456. E-mail: email@example.com.
1. Hassan F, Lewis TC, Davis MM, Gebremariam A, Dombkowski K. Hospital utilization and costs among children with influenza, 2003. Am J Prev Med. 2009;36(4):292-296.
2. Erhart LM, Rangel MC, Lu PJ, Singleton JA. Prevalence and characteristics of children at increased risk for complications from influenza, United States, 2000. J Pediatr. 2004;144(2):191-195.
3. Bhat N, Wright JG, Broder KR, et al. Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med. 2005; 353(24):2559-2567.
4. Neuzil KM, Wright PF, Mitchel EF, Jr., Griffin MR. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr. 2000;137(6):856-864.
5. Glezen WP, Greenberg SB, Atmar RL, Piedra PA, Couch RB. Impact of respiratory virus infections on persons with chronic underlying conditions. JAMA. 2000;283(4):499-505.
6. Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-10):1-42.
7. Surgeon General’s Advisory Committee on Influenza: United States Public Health Service. Recommendations for influenza immunization and control in the civilian population. Washington, DC; 1962.
8. Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2009; 58(RR-8):1-52.
9. Daley MF, Beaty BL, Barrow J, et al. Missed opportunities for influenza vaccination in children with chronic medical conditions. Arch Pediatr Adolesc Med. 2005;159(10):986-991.
10. Centers for Disease Control and Prevention. Influenza Vaccination Coverage Among Children With Asthma --- United States, 2005-06 Influenza Season. Morb Mortal Wkly Rep. 2008;57(24):653-657.
11. Dombkowski KJ, Davis MM, Cohn LM, Clark SJ. Effect of missed opportunities on influenza vaccination rates among children with asthma. Arch Pediatr Adolesc Med. 2006;160(9):966-971.
12. Kramarz P, DeStefano F, Gargiullo PM, et al; Vaccine Safety Datalink Team. Influenza vaccination in children with asthma in health maintenance organizations. Vaccine. 2000;18(21):2288-2294.
13. Szilagyi PG, Rodewald LE. Missed opportunities for influenza vaccination among children with asthma. Pediatr Infect Dis J. 1992;11(9): 705-708.
14. Gnanasekaran SK, Finkelstein JA, Lozano P, Farber HJ, Chi FW, Lieu TA. Influenza vaccination among children with asthma in Medicaid managed care. Ambul Pediatr. 2006;6(1):1-7.
15. Chung EK, Casey R, Pinto-Martin JA, Pawlowski NA, Bell LM. Routine and influenza vaccination rates in children with asthma. Ann Allergy Asthma Immunol. 1998;80(4):318-322.
16. Task Force on Community Preventive Services. Guide to Community Preventive Services. Universally recommended vaccinations: client reminder & recall systems. http://www.thecommunityguide.org/ vaccines/universally/clientreminder.html. Published 2010. Accessed December 2, 2010.
17. Daley MF, Barrow J, Pearson K, et al. Identification and recall of children with chronic medical conditions for influenza vaccination. Pediatrics. 2004;113(1, pt 1):e26-e33.
18. Dombkowski KJ, Lamarand K, Dong S, Perng W, Clark SJ. Using Medicaid claims to identify children with asthma. J Public Health Mgmt Pract. 2012;18(3):196-203.
19. Clark SJ, Lamarand K, Dombkowski KJ. Identifying children with chronic conditions for influenza vaccination using a statewide immunization registry: initial experiences of primary care providers. J Public Health Mgmt Pract. 2012;18(3):204-208.
20. Kozyrskyj AL, Mustard CA, Becker AB. Identifying children with persistent asthma from healthcare administrative records. Can Respir J. 2004;11(2):141-145.
21. Buescher PA, Jones-Vessey K. Using Medicaid data to estimate state- and county-level prevalence of asthma among low-income children. Matern Child Health J. 1999;3(4):211-216.
22. Mosen DM, Macy E, Schatz M, et al. How well do the HEDIS asthma inclusion criteria identify persistent asthma? Am J Manag Care. 2005;11(10):650-654.
23. Berger WE, Legorreta AP, Blaiss MS, et al. The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict asthma-related outcomes. Ann Allergy Asthma Immunol. 2004;93(6):538-545.
24. Fuhlbrigge AL, Carey VJ, Finkelstein JA, et al. Validity of the HEDIS criteria to identify children with persistent asthma and sustained high utilization. Am J Manag Care. 2005;11(5):325-330.
25. Schatz M, Zeiger RS, Yang SJ, et al. Persistent Asthma Defined Using HEDIS Versus Survey Criteria. Am J Manag Care. 2010;16(11): 281-288.
26. Mosen D, Macy E, Schatz M, et al. How Well Do the HEDIS asthma inclusion criteria identify persistent asthma? Am J Manag Care. 2005; 11:650-654.
27. Boulton ML, Grossman AM, Potter R, Vranesich PA, Clayton J. Assessing the relationship between seasonal and H1N1 influenza vaccination status in Michigan children, 2009-2010. Public Health Rep. 2011; 126(suppl 2):70-77.
28. Lemon HM, Darden PM. Measuring practice immunization rates quickly and accurately in the era of HIPAA: validation of the quick count method in practice settings. J S C Med Assoc. 2008;104(6): 194-197.
29. Dombkowski KJ, Clark SJ. Redefining Meaningful Use: Achieving Interoperability with Immunization Registries. Am J Prev Med. 2012;42(4):e33-e35.
30. Dombkowski KJ, Harrington LB, Dong S, Clark SJ. Seasonal influenza vaccination reminders for children with high risk conditions a registry-based randomized trial. Am J Prev Med. 2012;42(1):71-75.
31. Dombkowski KJ, Costello LE, Harrington LB, Dong S, Kolasa M, Clark SJ. Age-Specific Strategies for Immunization Reminders and Recalls: A Registry-Based Randomized Trial. Am J Prev Med. 2014; S0749-3797(14)00105-6. doi: 10.1016/j.amepre.2014.02.009.