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A Comparison of Multiple Data Sources to Identify Vaccinations for Veterans with Spinal Cord Injuries and Disorders

Affiliations of the authors: Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services and Policy Research, Hines Veterans Administration Hospital, Hines, IL, and Institute for Health Services and Policy Research, Northwestern University, Chicago, IL (FMW); Departments of Rehabilitation Medicine and Biomedical and Health Informatics, University of Washington School of Medicine, and Rehabilitation Care Services, Puget Sound VA Health Care System, Seattle, WA (MH); Hines VA Hospital, Hines, IL (CTE, BS, SLL); Puget Sound VA Health Care System, Seattle, WA (CW, MWL); and Spinal Cord Injury Quality Enhancement Research Initiative, Spinal Cord Injury and Disorders Strategic Healthcare Group, Puget Sound VA Health Care System, and Department of Rehabilitation Medicine, University of Washington, Seattle, WA (BG).

Correspondence and reprints: Frances M. Weaver, PhD, Midwest Center for Health Services and Policy Research, 151H, VA Hospital, Hines, IL 60141; e-mail: <weaver{at}research.hines.med.va.gov>.

Received for publication: 12/15/03; accepted for publication: 04/04/04.

Monitoring vaccination activity requires regular access to information about patient vaccination status. This report describes our experience using multiple Department of Veterans Affairs (VA) data sources to determine availability and completeness of vaccination information for veterans with spinal cord injuries and disorders (SCI&D). Administrative and clinical databases were limited to coding vaccine administration, undercounted vaccinations, and were unable to account for whether the vaccine was offered and the reasons for nonreceipt. Medical record review provided more detail but was labor intensive and costly. Patient surveys provided the richest information but were costly, time-consuming, and based on a sample of patients. Agreement was poor between data sources. This report suggests that while VA is well positioned to use national databases for clinical care decisions and to inform policy, vaccination data were incomplete. Electronic records must include data that are consistently entered and validated before they can be useful for care management and decision making.