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.