Kevin Czubachowski, Immunization Field Rep., MDCH Kyle Enger, Epidemiologist, MDCH

Searching for Pockets of Need: Searching for Pockets of Need: Using Registry Data and GIS Using Registry Data and GIS

Mapping to Identify Mapping to Identify Immunization Coverage LevelsImmunization Coverage Levels

Kevin Czubachowski, Immunization Field Rep., MDCHKevin Czubachowski, Immunization Field Rep., MDCHKyle Enger, Epidemiologist, MDCHKyle Enger, Epidemiologist, MDCH

Priya Nair, Epidemiologist, Genesee Co. Health Dept.Priya Nair, Epidemiologist, Genesee Co. Health Dept.Wendy Nye, Region 4 MCIR, Genesee Co. Health Dept.Wendy Nye, Region 4 MCIR, Genesee Co. Health Dept.

Region 4 MCIRRegion 4 MCIR Michigan separated into six regionsMichigan separated into six regions

• Region 4 covers 9 “thumb” countiesRegion 4 covers 9 “thumb” counties Region charged with:Region charged with:

• Training and provider complianceTraining and provider compliance• Monitoring provider/county ratesMonitoring provider/county rates• Maintaining provider databaseMaintaining provider database• Participation in local iz coalitionsParticipation in local iz coalitions• Assisting LHDs with accreditationAssisting LHDs with accreditation• Collaborating with LHDs and providersCollaborating with LHDs and providers

Looking for Pockets of NeedLooking for Pockets of Need Idea generated by Genesee County Idea generated by Genesee County

Partnership for Immunizations Partnership for Immunizations • Data and Assessment subcommitteeData and Assessment subcommittee

Proposal to the State of MichiganProposal to the State of Michigan Use of registry data as well as Use of registry data as well as

regional provider databaseregional provider database Region pulled initial dataRegion pulled initial data

• Deduplicated data prior to final pullDeduplicated data prior to final pull

Stages in the mapping processStages in the mapping process Data pullData pull

• Genesee Co. residents turning 2 yrs. old in 2002Genesee Co. residents turning 2 yrs. old in 2002• Immunizations given on/before 12/31/02Immunizations given on/before 12/31/02

Data cleaning and recodingData cleaning and recoding• DeduplicationDeduplication• Immunization data cleaning and recodingImmunization data cleaning and recoding• Address data cleaningAddress data cleaning

GeocodingGeocoding Mapping (still in progress)Mapping (still in progress) Analysis/interpretation (still in progress)Analysis/interpretation (still in progress)

Data Cleaning ProcessData Cleaning Process(used SAS 8, ArcView 8.3)(used SAS 8, ArcView 8.3)

ImmunizationsImmunizations• Separate antigensSeparate antigens• Delete obvious Delete obvious

invalid dosesinvalid doses Imms given before 6 Imms given before 6

wks except Hep Bwks except Hep B MMR & Var < 1 yr.MMR & Var < 1 yr. If same antigen If same antigen

given < 4 wks apart, given < 4 wks apart, 22ndnd deleted deleted

• Some invalid doses Some invalid doses remainremain

• Missing dataMissing data

AddressesAddresses• Used resp. party dataUsed resp. party data• Error correctionError correction

Correct street errorsCorrect street errors Check/correct ZIPsCheck/correct ZIPs Remove unnecessary Remove unnecessary

address dataaddress data• GeocodeGeocode• Check & correct Check & correct

unmatched addressesunmatched addresses• Re-geocode Re-geocode

Sources of ErrorSources of Error(and how they were addressed)(and how they were addressed)

Geocode errorsGeocode errors• Extensive address data cleaningExtensive address data cleaning• Consulted local GIS expertConsulted local GIS expert

Map framework errorsMap framework errors• Most recent road data (release 8/5/03)Most recent road data (release 8/5/03)

Immunization/record errorsImmunization/record errors• Removed many invalid shots, but not allRemoved many invalid shots, but not all• # shots missing unclear and varies by location; # shots missing unclear and varies by location;

registry not yet completeregistry not yet complete Child-level errorsChild-level errors

• Studied 2 yr. olds, Studied 2 yr. olds, addresses updated addresses updated• Records de-duplicatedRecords de-duplicated

43133 Map Interpretation43133 Map Interpretation Highest rates have lowest populationHighest rates have lowest population Most census tracts have coverage Most census tracts have coverage

rates of 60-75% of 2 yr. oldsrates of 60-75% of 2 yr. olds Further analysis will determine:Further analysis will determine:

• Medical homeMedical home• Barriers to care/resources availableBarriers to care/resources available• Economic level of communityEconomic level of community• Provider data completenessProvider data completeness

Completeness vs. Iz CoverageCompleteness vs. Iz Coverage

Future DirectionsFuture Directions Sharing informationSharing information Relationship of medical home to Relationship of medical home to

geographygeography Use census data to find factors Use census data to find factors

associated with iz. coverage associated with iz. coverage Use information to increase coverage Use information to increase coverage

Lessons Learned…Lessons Learned… Data overload (Pandora’s Box)!!!Data overload (Pandora’s Box)!!! Over 200 person hoursOver 200 person hours Analysis leads to data quality Analysis leads to data quality

improvementimprovement High level of GIS expertise helpful, High level of GIS expertise helpful,

but not necessarybut not necessary

AcknowledgementsAcknowledgements Pam Kowalske, Region 4 MCIRPam Kowalske, Region 4 MCIR Pete Apgar, Genesee County EqualizationPete Apgar, Genesee County Equalization Bobby Pestronk, Genesee County Health Bobby Pestronk, Genesee County Health

DepartmentDepartment Bob Swanson, Manager of Assessment and Bob Swanson, Manager of Assessment and

Local Support, MDCHLocal Support, MDCH

Contact InformationContact Information Kyle Enger, Epidemiologist, MDCHKyle Enger, Epidemiologist, MDCH

• engerk@michigan.govengerk@michigan.gov Kevin Czubachowski, Immunization Kevin Czubachowski, Immunization

Field Rep., MDCHField Rep., MDCH• czubachowskik@michigan.govczubachowskik@michigan.gov

Wendy Nye, Region 4 MCIRWendy Nye, Region 4 MCIR• wnye@co.genesee.mi.uswnye@co.genesee.mi.us

Priya Nair, Genesee Co. Health Dept.Priya Nair, Genesee Co. Health Dept.• pnair@co.genesee.mi.uspnair@co.genesee.mi.us