vices, they needed new policy tools—such as information management systems and collaborative partnerships with health plans and private providers—to manage their growing and sometimes unfamiliar responsibilities for oversight of the delivery of those services.

DISCUSSION

Questions and comments from workshop participants touched on various concerns for the immunization programs of the state and of local health departments. Given the likely constraints on future federal and state funding for immunization infrastructure activities, the prospects for county-level funding were discussed. In both Los Angeles and San Diego, however, county funding is expected to decline from current levels. For example, San Diego County may discontinue its support for the immunization registry. In Los Angeles, cuts are expected for the DHS facilities and staff where the health department provides immunization services.

Dr. Fielding commented on the challenges of meeting the immunization needs of the highly diverse population of Los Angeles. He noted that the county lacks good data on the full range of ethnic subgroups being served. He emphasized, however, that keeping immunization connected to other aspects of health care is a priority and that one approach taken by the health department has been to establish service contracts with several clinics based in particular ethnic communities. Those clinics, which have 700,000 visits per year, help provide access to culturally competent health care staff. The ethnic diversity in the county is so great, however, that the health department cannot afford to produce community education materials in all relevant languages.

Also discussed was the experience at the state and local levels in working with private providers on quality assurance for immunization services. To detect and correct problems such as improper vaccine storage and handling practices, the state has been working in partnership with the California chapters of the American Academy of Pediatrics and the American Academy of Family Physicians to visit about 1,000 VFC physician practices each year. The state also works with managed care organizations to address quality improvement issues. Additional oversight and training occur at the local level.

A workshop participant encouraged efforts to reduce the administrative burden associated with data entry for immunization registries. Less burdensome data entry might increase provider participation. A workshop participant noted that the Centers for Medicare and Medicaid Services has awarded a grant to the L.A. Care health plan to assess the information system needs of its participating providers.



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