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Mapping the Colorado Immunization Information System in the Denver Area

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GeCo in the Rockies

This document summarizes Lauren Snyder's presentation on mapping Colorado's Immunization Information System (CIIS) in the Denver area. The presentation discusses why CIIS mapping is important, applications of CIIS data like measuring vaccination rates, and challenges in analyzing CIIS data like choosing an accurate population denominator. Snyder concludes that spatial analysis of CIIS data could help correlate immunization rates with disease incidence and other factors, and that mapping CIIS data in a business intelligence context warrants further exploration.

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© 2014 Denver Public Health Mapping the Colorado Immunization Information System in the Denver Area Lauren Elizabeth Snyder, MPH Denver Public Health Applied Public Health Fellowship Program Sept. 25, 2014 GeCo in the Rockies
© 2014 Denver Public Health •Key terms •Why CIIS? •Applications •The challenges –Rates and deciding on a denominator •Next steps Agenda
© 2014 Denver Public Health Key terms •Immunization Information Systems •Vaccine Schedule •Healthy People 2020 •Antigen •Incidence
© 2014 Denver Public Health Why CIIS? CIIS Mapping Spatial Visualization Informatics Public Health
© 2014 Denver Public Health Source: http://www.vaccines.gov/basics/protection/ Public Health
© 2014 Denver Public Health Source: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html Informatics
© 2014 Denver Public Health Spatial Visualization
© 2014 Denver Public Health Estimated Vaccination Coverage,*† with Individual Vaccines and Selected Vaccination Series Among Children Aged 19-35 Months§ by State -- National Immunization Survey, United States, 2013 Antigen 3+DTaP¶ 4+DTaP** 3+Polio†† 1+MMR §§ 3+Hib¶¶ Hib- PS*** Hib- FS††† 3+HepB§§§ HepB Birth dose¶¶¶ 1+Var** ** 3+PCV† ††† 4+PCV§ §§§ 1+HepA¶¶¶¶ 2+HepA***** Rotavirus††††† 4:3:1§§§ §§ 4:3:1:3 ¶¶¶¶¶ US National 94.1±0.9 83.1±1.3 92.7±1.0 91.9±0.9 92.8±0.9 93.7±0.9 82.0±1.3 90.8±1.0 74.2±1.4 91.2±0.9 92.4±1.0 82.0±1.3 83.1±1.2 54.7±1.6 72.6±1.5 81.5±1.3 81.1±1.3 Colorado 91.7±4.5 81.2±6.0 90.3±4.7 86.0±5.5 90.1±4.8 90.8±4.8 82.8±5.8 84.1±5.6 60.2±7.3 84.8±5.6 91.0±4.6 84.0±5.6 73.2±6.6 47.6±7.4 73.8±6.6 79.7±6.1 78.9±6.2 Antigen 4:3:1:3- PS****** 4:3:1:4- FS†††††† 4:3:1:3:3 §§§§§§ 4:3:1:3:3-PS¶¶¶¶¶¶ 4:3:1:4:3- FS******* 4:3:1:3:3:1†††††† † 4:3:1:0:3:1§§§§§§§ 4:3:1:3:3:1- PS¶¶¶¶¶¶¶ 4:3:1:4:3:1- FS******* * 4:3:1:3:3:1:4††††††† † 4:3:1:0:3:1:4§§§§§§§ § 4:3:1:3:3:1:4- PS¶¶¶¶¶¶¶ ¶ 4:3:1:4:3:1:4- FS******* ** US National 81.2±1.3 77.1±1.4 78.7±1.3 78.8±1.3 75.0±1.4 77.7±1.4 77.9±1.4 77.7±1.4 74.0±1.4 72.6±1.5 72.7±1.5 72.7±1.5 70.4±1.5 Colorado 78.9±6.2 77.4±6.3 73.4±6.7 73.4±6.7 72.2±6.7 72.1±6.8 72.9±6.7 72.1±6.8 71.0±6.8 70.3±6.9 70.3±6.9 70.3±6.9 69.2±6.9 *Highlighted indicates below national average; red font indicates below healthy people 2020 target
© 2014 Denver Public Health Estimated Vaccination Coverage,*† with Individual Vaccines and Selected Vaccination Series Among Children Aged 19-35 Months§ by State -- National Immunization Survey, United States, 2013 Antigen 3+DTaP¶ 4+DTaP** 3+Polio†† 1+MMR §§ 3+Hib¶¶ Hib- PS*** Hib- FS††† 3+HepB§§§ HepB Birth dose¶¶¶ 1+Var** ** 3+PCV† ††† 4+PCV§ §§§ 1+HepA¶¶¶¶ 2+HepA***** Rotavirus††††† 4:3:1§§§ §§ 4:3:1:3 ¶¶¶¶¶ US National 94.1±0.9 83.1±1.3 92.7±1.0 91.9±0.9 92.8±0.9 93.7±0.9 82.0±1.3 90.8±1.0 74.2±1.4 91.2±0.9 92.4±1.0 82.0±1.3 83.1±1.2 54.7±1.6 72.6±1.5 81.5±1.3 81.1±1.3 Colorado 91.7±4.5 81.2±6.0 90.3±4.7 86.0±5.5 90.1±4.8 90.8±4.8 82.8±5.8 84.1±5.6 60.2±7.3 84.8±5.6 91.0±4.6 84.0±5.6 73.2±6.6 47.6±7.4 73.8±6.6 79.7±6.1 78.9±6.2 Antigen 4:3:1:3- PS****** 4:3:1:4- FS†††††† 4:3:1:3:3 §§§§§§ 4:3:1:3:3-PS¶¶¶¶¶¶ 4:3:1:4:3- FS******* 4:3:1:3:3:1†††††† † 4:3:1:0:3:1§§§§§§§ 4:3:1:3:3:1- PS¶¶¶¶¶¶¶ 4:3:1:4:3:1- FS******* * 4:3:1:3:3:1:4††††††† † 4:3:1:0:3:1:4§§§§§§§ § 4:3:1:3:3:1:4- PS¶¶¶¶¶¶¶ ¶ 4:3:1:4:3:1:4- FS******* ** US National 81.2±1.3 77.1±1.4 78.7±1.3 78.8±1.3 75.0±1.4 77.7±1.4 77.9±1.4 77.7±1.4 74.0±1.4 72.6±1.5 72.7±1.5 72.7±1.5 70.4±1.5 Colorado 78.9±6.2 77.4±6.3 73.4±6.7 73.4±6.7 72.2±6.7 72.1±6.8 72.9±6.7 72.1±6.8 71.0±6.8 70.3±6.9 70.3±6.9 70.3±6.9 69.2±6.9 *Highlighted indicates below national average; red font indicates below healthy people 2020 target Take away message is that CO is behind national immunization levels for young children and not currently on track to meet the healthy people 2020 target
© 2014 Denver Public Health Background Colorado Immunization Information System: •Statewide, confidential, computerized •Maintains records for children & adults •Financial incentive (through Meaningful Use), but not required to report to CIIS •Patients and providers can opt out •As of May 2014, CIIS held approximately 45.3 million immunization services for 4.2 million individuals.
© 2014 Denver Public Health Applications •Overall vs. antigen specific penetration •Up to date/ not up to date •Incidence •Protecting confidentiality Confirmed Pertussis Cases, 0-18 years, Denver County, 2012
© 2014 Denver Public Health Rates •Important and difficult –Number affected, infected, immune –Choosing a denominator is tricky •In and out movement of people •Young and old age groups especially of interest •Differing data sources locate people differently
© 2014 Denver Public Health •Federally administered •Collected every ten years •Attempts to sample everyone 2010 Census •Small sample collected every year, 5 yr average •5 year age groupings •Not recommended for population estimates American Community Survey 5 year estimate •Associated cost, new data pulls each year and age groups, concern for public health •Less institutional knowledge about methodology Commercial 2013 estimate •New data source •Issues with patient and provider opt out, data cleanliness CIIS counts Deciding on a Denominator Trust Timeliness/growth
© 2014 Denver Public Health Differences with Denominators
© 2014 Denver Public Health Suggestions/Recommendations •Know your data, know your audience •Make logic clear on maps •Series of maps can be helpful to end users •Generally, ACS is not recommended for population estimates
© 2014 Denver Public Health Next steps •Spatial analysis: –Immunization status and disease incidence correlation, other factors and models •Ordinary Least Squares and Moran’s I –Mapping in a business intelligence context –Regional mapping –Bivariate mapping
© 2014 Denver Public Health Acknowledgements: (DPH Team) Arthur Davidson, MD, MSPH Dean McEwen, MBA Moises Maravi, MSc Judy Shlay, MD, MSPH Christie Mettenbrink, MSPH Theresa Mickiewicz, MSPH Kaylynn Aiona, MPH Kelly Gerard, MS Lourdes Yun, MD, MSPH Kathryn DeYoung, MS This study/report was supported in part by an appointment to the Applied Public Health Informatics Fellowship Program administered by CSTE and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement 3U38HM000414-04W1.
© 2014 Denver Public Health Questions? Lauren.snyder@dhha.org 303.602.3680

More Related Content

Mapping the Colorado Immunization Information System in the Denver Area

  • 1. © 2014 Denver Public Health Mapping the Colorado Immunization Information System in the Denver Area Lauren Elizabeth Snyder, MPH Denver Public Health Applied Public Health Fellowship Program Sept. 25, 2014 GeCo in the Rockies
  • 2. © 2014 Denver Public Health •Key terms •Why CIIS? •Applications •The challenges –Rates and deciding on a denominator •Next steps Agenda
  • 3. © 2014 Denver Public Health Key terms •Immunization Information Systems •Vaccine Schedule •Healthy People 2020 •Antigen •Incidence
  • 4. © 2014 Denver Public Health Why CIIS? CIIS Mapping Spatial Visualization Informatics Public Health
  • 5. © 2014 Denver Public Health Source: http://www.vaccines.gov/basics/protection/ Public Health
  • 6. © 2014 Denver Public Health Source: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html Informatics
  • 7. © 2014 Denver Public Health Spatial Visualization
  • 8. © 2014 Denver Public Health Estimated Vaccination Coverage,*† with Individual Vaccines and Selected Vaccination Series Among Children Aged 19-35 Months§ by State -- National Immunization Survey, United States, 2013 Antigen 3+DTaP¶ 4+DTaP** 3+Polio†† 1+MMR §§ 3+Hib¶¶ Hib- PS*** Hib- FS††† 3+HepB§§§ HepB Birth dose¶¶¶ 1+Var** ** 3+PCV† ††† 4+PCV§ §§§ 1+HepA¶¶¶¶ 2+HepA***** Rotavirus††††† 4:3:1§§§ §§ 4:3:1:3 ¶¶¶¶¶ US National 94.1±0.9 83.1±1.3 92.7±1.0 91.9±0.9 92.8±0.9 93.7±0.9 82.0±1.3 90.8±1.0 74.2±1.4 91.2±0.9 92.4±1.0 82.0±1.3 83.1±1.2 54.7±1.6 72.6±1.5 81.5±1.3 81.1±1.3 Colorado 91.7±4.5 81.2±6.0 90.3±4.7 86.0±5.5 90.1±4.8 90.8±4.8 82.8±5.8 84.1±5.6 60.2±7.3 84.8±5.6 91.0±4.6 84.0±5.6 73.2±6.6 47.6±7.4 73.8±6.6 79.7±6.1 78.9±6.2 Antigen 4:3:1:3- PS****** 4:3:1:4- FS†††††† 4:3:1:3:3 §§§§§§ 4:3:1:3:3-PS¶¶¶¶¶¶ 4:3:1:4:3- FS******* 4:3:1:3:3:1†††††† † 4:3:1:0:3:1§§§§§§§ 4:3:1:3:3:1- PS¶¶¶¶¶¶¶ 4:3:1:4:3:1- FS******* * 4:3:1:3:3:1:4††††††† † 4:3:1:0:3:1:4§§§§§§§ § 4:3:1:3:3:1:4- PS¶¶¶¶¶¶¶ ¶ 4:3:1:4:3:1:4- FS******* ** US National 81.2±1.3 77.1±1.4 78.7±1.3 78.8±1.3 75.0±1.4 77.7±1.4 77.9±1.4 77.7±1.4 74.0±1.4 72.6±1.5 72.7±1.5 72.7±1.5 70.4±1.5 Colorado 78.9±6.2 77.4±6.3 73.4±6.7 73.4±6.7 72.2±6.7 72.1±6.8 72.9±6.7 72.1±6.8 71.0±6.8 70.3±6.9 70.3±6.9 70.3±6.9 69.2±6.9 *Highlighted indicates below national average; red font indicates below healthy people 2020 target
  • 9. © 2014 Denver Public Health Estimated Vaccination Coverage,*† with Individual Vaccines and Selected Vaccination Series Among Children Aged 19-35 Months§ by State -- National Immunization Survey, United States, 2013 Antigen 3+DTaP¶ 4+DTaP** 3+Polio†† 1+MMR §§ 3+Hib¶¶ Hib- PS*** Hib- FS††† 3+HepB§§§ HepB Birth dose¶¶¶ 1+Var** ** 3+PCV† ††† 4+PCV§ §§§ 1+HepA¶¶¶¶ 2+HepA***** Rotavirus††††† 4:3:1§§§ §§ 4:3:1:3 ¶¶¶¶¶ US National 94.1±0.9 83.1±1.3 92.7±1.0 91.9±0.9 92.8±0.9 93.7±0.9 82.0±1.3 90.8±1.0 74.2±1.4 91.2±0.9 92.4±1.0 82.0±1.3 83.1±1.2 54.7±1.6 72.6±1.5 81.5±1.3 81.1±1.3 Colorado 91.7±4.5 81.2±6.0 90.3±4.7 86.0±5.5 90.1±4.8 90.8±4.8 82.8±5.8 84.1±5.6 60.2±7.3 84.8±5.6 91.0±4.6 84.0±5.6 73.2±6.6 47.6±7.4 73.8±6.6 79.7±6.1 78.9±6.2 Antigen 4:3:1:3- PS****** 4:3:1:4- FS†††††† 4:3:1:3:3 §§§§§§ 4:3:1:3:3-PS¶¶¶¶¶¶ 4:3:1:4:3- FS******* 4:3:1:3:3:1†††††† † 4:3:1:0:3:1§§§§§§§ 4:3:1:3:3:1- PS¶¶¶¶¶¶¶ 4:3:1:4:3:1- FS******* * 4:3:1:3:3:1:4††††††† † 4:3:1:0:3:1:4§§§§§§§ § 4:3:1:3:3:1:4- PS¶¶¶¶¶¶¶ ¶ 4:3:1:4:3:1:4- FS******* ** US National 81.2±1.3 77.1±1.4 78.7±1.3 78.8±1.3 75.0±1.4 77.7±1.4 77.9±1.4 77.7±1.4 74.0±1.4 72.6±1.5 72.7±1.5 72.7±1.5 70.4±1.5 Colorado 78.9±6.2 77.4±6.3 73.4±6.7 73.4±6.7 72.2±6.7 72.1±6.8 72.9±6.7 72.1±6.8 71.0±6.8 70.3±6.9 70.3±6.9 70.3±6.9 69.2±6.9 *Highlighted indicates below national average; red font indicates below healthy people 2020 target Take away message is that CO is behind national immunization levels for young children and not currently on track to meet the healthy people 2020 target
  • 10. © 2014 Denver Public Health Background Colorado Immunization Information System: •Statewide, confidential, computerized •Maintains records for children & adults •Financial incentive (through Meaningful Use), but not required to report to CIIS •Patients and providers can opt out •As of May 2014, CIIS held approximately 45.3 million immunization services for 4.2 million individuals.
  • 11. © 2014 Denver Public Health Applications •Overall vs. antigen specific penetration •Up to date/ not up to date •Incidence •Protecting confidentiality Confirmed Pertussis Cases, 0-18 years, Denver County, 2012
  • 12. © 2014 Denver Public Health Rates •Important and difficult –Number affected, infected, immune –Choosing a denominator is tricky •In and out movement of people •Young and old age groups especially of interest •Differing data sources locate people differently
  • 13. © 2014 Denver Public Health •Federally administered •Collected every ten years •Attempts to sample everyone 2010 Census •Small sample collected every year, 5 yr average •5 year age groupings •Not recommended for population estimates American Community Survey 5 year estimate •Associated cost, new data pulls each year and age groups, concern for public health •Less institutional knowledge about methodology Commercial 2013 estimate •New data source •Issues with patient and provider opt out, data cleanliness CIIS counts Deciding on a Denominator Trust Timeliness/growth
  • 14. © 2014 Denver Public Health Differences with Denominators
  • 15. © 2014 Denver Public Health Suggestions/Recommendations •Know your data, know your audience •Make logic clear on maps •Series of maps can be helpful to end users •Generally, ACS is not recommended for population estimates
  • 16. © 2014 Denver Public Health Next steps •Spatial analysis: –Immunization status and disease incidence correlation, other factors and models •Ordinary Least Squares and Moran’s I –Mapping in a business intelligence context –Regional mapping –Bivariate mapping
  • 17. © 2014 Denver Public Health Acknowledgements: (DPH Team) Arthur Davidson, MD, MSPH Dean McEwen, MBA Moises Maravi, MSc Judy Shlay, MD, MSPH Christie Mettenbrink, MSPH Theresa Mickiewicz, MSPH Kaylynn Aiona, MPH Kelly Gerard, MS Lourdes Yun, MD, MSPH Kathryn DeYoung, MS This study/report was supported in part by an appointment to the Applied Public Health Informatics Fellowship Program administered by CSTE and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement 3U38HM000414-04W1.
  • 18. © 2014 Denver Public Health Questions? Lauren.snyder@dhha.org 303.602.3680