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Methods:
A clinical database is maintained by the Department of General Academic
Pediatrics at Children's Hospital of Pittsburgh
which includes immunizations and problems lists. This information
is entered into the database by periodically extracting information from the
hospital billing system, using ICD-9 codes which appear on a standardized
billing form. Immunizations for influenza (ICD-9 code = V04.8) have been
entered into an immunization datafile since the fall of 1992. ICD-9 codes
have been entered into a problem list datafile since December, 1995.
Determining which patients are due for the influenza vaccine involve
reviewing patients' immunization records and problem lists. A computerized
routine which identifies the majority of this patient population
works as follows:
- All 'active' patients are identified. These are patients who currently
have an assignment to a primary care provider at Children's Hospital
of Pittsburgh as determined by the policies of the Department of General
Academic Pediatrics.
- For each patient, his/her immunization record is reviewed to check if
the patient has a history of receiving a flu shot.
- For each patient, his/her problem list is reviewed to see if any of
the corresponding ICD-9 codes match the following list of ICD-9 codes,
identified as a subset of those diagnoses for which a flu shot is recommended:
| ICD-9 Code |
Billing Sheet Description |
ICD-9 Code Description |
| 282.6 |
Sickle cell anemia, please specify |
Sickle Cell Anemia |
| 282.60 |
Sickle cell anemia, please specify |
Sickle Cell Anemia, Unspecified |
| 042 |
HIV Asymptomatic Infection |
HIV Infection With Specified Condition |
| 042.9 |
HIV Symptomatic Infection/AIDS |
Acquired Immunodeficiency Syndrome, Unspecified |
| 250.01 |
IDDM w/o complication |
Type I Diabetes Mellitus w/o Mention of Complication |
| 493.90 |
Asthma |
Asthma, Unspecified, w/o Mention of Status Asthmaticus |
| 770.7 |
Bronchopulmonary Dysplasia |
Chronic Respiratory Disease Arising in the Perinatal Period |
| 786.09 |
Wheezing/Bronchospasm/RAD |
Other Dyspnea and Respiratory Abnormality |
| 277.00 |
|
Cystic Fibrosis w/o Mention of Meconium Ileus |
Results:
- As of September 12, 1999, the total number of active patients
identified is 11,917.
- Of that total, 253 or 2.1% have a [+] history of receiving the flu
vaccine, but have [-] match in their problem list.
- 482 or 4.0% have a [+] history of receiving the flu vaccine and also
have a [+] match in their problem list.
- Significantly, 1,537 or 12.9% have a [+] match in their problem list, but
have [-] history of ever receiving the flu vaccine. This represents 67.6% or
two-thirds of the total 2,272 patients identified as potential flu vaccine
recipients.
- A tabular summary is as follows:
| Total Number of Active Patients | 11,917 |
| No. of Pts. with [-] Problem List Match and [-] Flu Shot Hx |
9,645 |
| No. of Pts. with [-] Problem List Match and [+] Flu Shot Hx |
253 |
| No. of Pts. with [+] Problem List Match and [-] Flu Shot Hx |
1,537 |
| No. of Pts. with [+] Problem List Match and [+] Flu Shot Hx |
482 |
Comments:
- The patients who have received flu vaccine in the past but don't have
a match in their problem list could represent patients who are siblings of
those who also receive flu vaccine, OR could represent patients who do
not have appropriate ICD-9 diagnoses codings entered yet for which a flu
vaccine is recommended.
- This is the first year that such a comprehensive review of potential
flu vaccine recipients has been conducted by computer. It will be interesting
to see the drop in percentage next year of those patients who need a flu vaccine
but have no history of ever receiving one.
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