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September's Quality Improvement Grantee Spotlight

HRSA's BPHC Grantee: The Colorado Community Managed Care Network Using Health IT for Increasing Immunization Rates in Health Centers

Colorado Community Managed Care Network logoIn celebration of “National Health IT Week” (September 12-16, 2011) this month the Health Resources and Services Administration’s (HRSA) Quality Improvement (QI) website is highlighting a HRSA grantee for their use of health information technology (IT) for improving healthcare quality and outcomes. The Colorado Community Managed Care Network (CCMCN), a grantee of the Bureau of Primary Health Care (BPHC) grantee, successfully generates actionable data and uses this information to target health interventions among their patient population. This use of healthcare IT and data resulted in improved immunization rates for Colorado Community Health Center (CCHC) patients two years and under. This initiative includes collaboration in evaluating and implementing QI activities, data collection and analysis to facilitate the upward trending of immunization rates. In addition, CCMCN’s pilot project uses health IT to inform the development of a general QI strategy, which includes solidifying the model of using actionable data to achieve greater healthcare outcomes, such as higher immunization rates.

Colorado Community Managed Care Network (CCMCN)

Since 1994, CCMCN, a Health Center Controlled Network, has worked in providing services that enable its members and their community partners to succeed as efficient, effective and accountable systems of care in Colorado. Its governing members currently include 12 of Colorado’s 15 health centers. In 2009, BPHC awarded CCMCN a Health IT Implementation QI grant, to improve immunization outcomes. The goal of this QI project was to utilize health IT data from an existing Colorado Associated Community Health Information Enterprise (CACHIE) program to strengthen established immunization activities and improve health center patient health outcomes. CACHIE, a health IT program within CCMCN, supports health centers and their community partners in improving the quality of care and health outcomes through a data driven QI processes. This BPHC funded QI project positively affected the lives of roughly 96,000 heath center patients. In addition, beginning in 2007, CCMCN utilized BPHC Health IT Innovations Grant funding that implemented a health information data warehouse and initiated health information exchange (HIE) efforts. This project helped compliment and strengthen CCMCN’s capability for improving health outcomes in accordance with the goals of their 2009 QI project.

The Importance of Accurate and Consistent Immunization Data

It is important that the data integrity processes ensured that the immunization data obtained from health center EHRs are complete, current and accurate. Without data containing these attributes, it would have been difficult to measure valid health outcomes and use the results as a tool for QI. It is critical when conducting QI work that data used for measuring health outcomes is accurate and consistent, in order to guide your QI work in a targeted direction. The accuracy and consistency of health data reporting was facilitated by using health IT and the CCMCN data warehouse as QI tools. To obtain this, CCMCN strengthened its data warehouse -which serves multiple electronic health record (EHR) platforms)- with templates to integrate, utilize and efficiently exchange all health information and data. CCMCN also worked in overcoming data collection differences between the Colorado Immunization Information System (CIIS) operated by the Colorado Department of Public Health and Environment and EHR/CACHIE reporting.


How CCMCN Uses EHR Data For Increasing Immunization Rates

This BPHC funded QI project utilized data from an existing CACHIE program and other health IT data sources, such as existing registries, to strengthen established immunization activities by using EHR data that improved health center  patient health outcomes. The ultimate goal was to increase up-to-date immunization rates of two year olds at participating clinics up to 80%. This innovative and integral QI project helped expand CACHIE’s current capacities, as well as more comprehensively extend health IT QI efforts throughout the CCMCN network in conjunction with its partner organization CCHN, Colorado’s Primary Care Association- which provided the clinical and coaching expertise under subcontract to CCMCN. There were eighteen clinics, at four Federally Qualified Health Centers, which participated in this QI project’s immunization initiative. CCMCN used this immunization data for partnering with these health centers for providing technical assistance for QI in immunization delivery and analysis of data compiled from EHRs, CIIS and CACHIE.

Reporting for this goal was conducted by measuring up-to-date immunization rates of 19-24 month old children.  Children were considered up-to-date on immunizations if they had received 4 DTaP, 3 IPV, 1 MMR, 3 Hib, 3 Hep B, 1 VZV, and 4 PCV, in accordance with intervals recommended by the Advisory Committee for Immunization Practices (ACIP).  

The figures below represent data from two of the CCMCN immunization program clinic sites.

Clinic 1

Immunization Data Trends of Vaccines 2008 62% of patients, 68.3% statewide; 2009 83.2% of patients, 72.7% statewide; 2010 81.3% of patients, 75.2% statewide

Clinic 2

Immunization Data Trends of Vaccines; 65.7% of patients, 68.3% statewide; 2000 77.1% of patients, 72.7% statewide; 2010 91.9% of patients, 75.2% statewide

 

These two charts represent a sample of the successful increase in immunization rates among this QI project’s health center patients. These greater health outcomes reflect how CCMCN used patient data from the health center’s health IT systems for  improving  how these health centers target and reach their patients who were not receiving immunizations.  

Conclusion

With the help of BPHC funding , CCMCN successfully worked with Colorado health centers  to ‘close the loop’ between outcome reporting and QI by improving immunization rates for children two years and under, through the strategic use of data. The extraction of complete, current, accurate, and valid immunization data from the CACHIE allowed CCMCN staff to provide technical assistance in the form of training, teleconferences, site visits, and monthly reports to the CHCs with the shared (and achieved) goal of increasing immunization rates.  In addition, by establishing a QI model using data from health center health IT systems, CCMCN’s immunization project assisted in enhancing preventive services and improving health outcomes. In addition, it is estimated that implementing this QI plan through data provided by healthc enter EHRs also yielded higher health outcomes in other clinical areas including: Diabetes Control, Screening, Brief Intervention, and Referral to Treatment for Alcohol and substance related disorders. These examples from CCMCN’s QI project demonstrate the importance of using health IT as a tool for successfully improving healthcare outcomes and driving quality in the safety net community. 

Please email Mr. Dan Tuteur, the Executive Director of Colorado Community Managed Care Network at dan@cachie.org for more information.