Using an immunization information system to improve accountability for vaccines distributed through the Vaccines for Children program in New York City- 2005-2008

BACKGROUND: As new- higher-priced vaccines are added to the immunization schedule- Vaccines for Children (VFC) program costs are increasing and attention has been focused on strengthening accountability. In New York City- the VFC program distributes publicly purchased vaccines- worth nearly \$117 million annually- to more than 1-500 enrolled facilities to immunize eligible children. In 2006- we changed our policy of requiring facilities to account for administration of VFC vaccines by submitting self-reported- aggregate doses administered reports (DARs) when ordering VFC vaccines to using DARs generated from our immunization information system (IIS)- the Citywide Immunization Registry (CIR). New York City providers have been required to report immunizations to the CIR since 1997. OBJECTIVES: To increase VFC accountability and reporting to the CIR by linking vaccine ordering and distribution to reporting of doses administered. METHODS: We matched all VFC facilities to those in the CIR. Using CIR and VFC data- we calculated a CIR-generated DAR percentage for each facility by dividing doses reported by doses distributed. We informed facilities that their CIR-generated DAR must be more than 90 percent or their VFC vaccine orders may be reduced. RESULTS: After the policy change- doses reported to the CIR for children younger than 8 years increased 71 percent- and the percentage of doses distributed that were reported as administered to eligible children increased from 40 to 67. Few facilities protested/ none dropped out of VFC. CONCLUSIONS: Replacing self-reported DARs with IIS-generated DARs improved VFC accountability and increased reporting to the IIS. Immunization programs nationwide may achieve similar success using this strategy.