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Identifying Children With Chronic Conditions for Influenza Vaccination Using a Statewide Immunization Registry: Initial Experiences of Primary Care Providers

Clark, Sarah J. MPH; Lamarand, Kara MPH; Dombkowski, Kevin J. DrPH

Journal of Public Health Management and Practice: May/June 2012 - Volume 18 - Issue 3 - p 204–208
doi: 10.1097/PHH.0b013e3182176eba

Context: Children with chronic medical conditions are at increased risk of complications from influenza, yet their vaccination rates are low. The Michigan Care Improvement Registry (MCIR), a statewide immunization registry, was expanded in 2006 to include an indicator, based on Medicaid administrative claims, that prompts providers to offer influenza vaccine to high-risk children (ie, those with chronic conditions).

Objective: To assess primary care providers' experiences with the MCIR high-risk indicator.

Design: A cross-sectional, self-administered survey mailed in July 2009.

Setting: State of Michigan.

Participants: A total of 300 family physicians and 300 pediatricians who served as primary care providers for children in Michigan's Medicaid program.

Main Outcome Measures: Provider experiences with the high-risk indicator; suggestions for improvement.

Results: Response rate was 79%. Only 32% of pediatricians and 17% of family physicians recalled seeing the high-risk indicator during the 2008–2009 influenza season. Of those who saw the indicator, 48% rated it as “helpful” or “very helpful” in identifying which children should receive flu vaccine. To improve its usefulness, 77% of respondents wanted the indicator to reflect all children, rather than only those enrolled in Medicaid, and 71% wanted MCIR to generate a list of high-risk children in their practice.

Conclusions: Three years after implementation, the registry-based high-risk indicator is not viewed by most providers. Half of those who saw the indicator found it helpful, and most respondents endorsed enhancements to broaden its scope. Future work should explore whether enhanced capabilities help to facilitate identification of priority cases by providers.

This study aims to assess the extent to which primary care providers were utilizing the Michigan Care Improvement Registry high-risk indicator and to solicit their suggestions for improvement.

Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor.

Correspondence: Sarah J. Clark, MPH, 300 N Ingalls, Rm 6E06, Ann Arbor, MI 48109 (

No financial disclosures were reported by the authors of this paper. This study was funded by the Blue Cross Blue Shield of Michigan Foundation.

The authors declare no conflict of interest.

© 2012 Lippincott Williams & Wilkins, Inc.