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Clinical Preventive Services

Integrated Initiatives


Tamara Lewis, M.D., Medical Director, Intermountain Health Care, Salt Lake City, UT.

Phillip Gresham, M.P.A., Centers for Disease Control (CDC) Public Health Advisor, Utah Department of Health, Immunization Program, Salt Lake City, UT.

In 1997, the State of Utah was ranked by the CDC as the worst State in the United States for childhood immunization rates. Intermountain Health Care (IHC), a large-market-share, high-retention-rate managed care organization (MCO), and the Utah Department of Health (UDOH) decided to team up to improve access to and delivery of these critical immunization services.

IHC discovered that the main reasons for low immunization rates in the State of Utah were:

  • Missed opportunities.
  • Lack of access.
  • Ineffective reminder systems.
  • Inconsistent messages being delivered to consumers.

Joint strategies to overcome these barriers included:

  • Setting health-status goals at the corporate level.
  • Identifying barriers and creating interventions.
  • Measuring and evaluating outcomes.
  • Focusing on school entry policies and requiring schools to administer vaccines.
  • Utilizing the Utah State Immunization Information System (USIIS).

The USIIS data collecting and tracking system, a repository of all immunization records in Utah, is funded by private health maintenance organizations, UDOH, and the Federal Government. The database can link to large systems, such as the Women, Infants, and Children program, and school records, as well as to individual providers. Reminder recall cards, Health Plan Employer Data and Information Set (HEDIS) reports, and school records are among some of the items USIIS can produce.

The joint program in Utah was successful in increasing the percentage of children receiving appropriate immunizations. By 1999, the State of Utah was ranked 32 out of 51, a 19-point increase in 2 years. However, Dr. Lewis stressed that many challenges must be overcome in order to promote effective collaboration and achieve significant results. Often, clinics lack the time and the resources to implement and sustain data-tracking systems. The system is only as good as the data it contains. Therefore, health workers must be committed to system implementation. Evidence from USIIS shows that efficient systems are both voluntary and realistic.

The IHC wants to keep improving the rates of immunization and other preventive services in Utah. To do this, they plan to involve patients and parents as advocates of the program and to link resources and share ideas with other States, including Idaho, Oregon, and Montana.

The joint effort between the IHC and UDOH proves that collaborative initiatives between the private sector and the public sector can be successful, especially in the area of preventive services.

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