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Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck?
Acad Pediatr. 2017 04; 17(3):330-338.APed

Abstract

OBJECTIVE

We compared the effectiveness and cost-effectiveness of: 1) centralized reminder/recall (C-R/R) using the Colorado Immunization Information System (CIIS) versus practice-based reminder/recall (PB-R/R) approaches to increase immunization rates; 2) different levels of C-R/R intensity; and 3) C-R/R with versus without the name of the child's provider.

METHODS

We conducted 3 sequential cluster-randomized trials involving children aged 19 to 25 months in 15 Colorado counties in March 2013 (trial 1), October 2013 (trial 2), and May 2014 (trial 3). In C-R/R counties, the intensity of the intervention decreased sequentially in trials 1 through 3, from 3 to 1 recall messages. In PB-R/R counties, practices were offered training using CIIS and financial support. The percentage of children with up-to-date (UTD) vaccinations was compared 6 months after recall. A mixed-effects model assessed the association between C-R/R versus PB-R/R and UTD rates.

RESULTS

C-R/R was more effective in trials 1 to 3 (relative risk = 1.11; 95% confidence interval 1.01-1.20; P = .009). Effectiveness did not decrease with decreasing intervention intensity (P = .59). Costs decreased with decreasing intensity in the C-R/R arm, from $18.72 per child brought UTD in trial 1 to $10.11 in trial 3. Costs were higher and more variable in the PB-R/R arm, ranging from $20.63 to $237.81 per child brought UTD. C-R/R was significantly more effective if the child's practice name was included (P < .0001).

CONCLUSIONS

C-R/R was more effective and cost-effective than PB-R/R for increasing UTD rates in young children and was most effective if messages included the child's provider name. Three reminders were not more effective than one, which may be explained by the increasing accuracy of contact information in CIIS over the course of the trials.

Authors+Show Affiliations

Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, Colo. Electronic address: allison.kempe@childrenscolorado.org.Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo.Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo.Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo; Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, Colo.Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo.Department of Health Policy and Management and Department of Pediatrics, University of South Florida, Tampa, Fla.Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

27913163

Citation

Kempe, Allison, et al. "Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck?" Academic Pediatrics, vol. 17, no. 3, 2017, pp. 330-338.
Kempe A, Saville AW, Beaty B, et al. Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck? Acad Pediatr. 2017;17(3):330-338.
Kempe, A., Saville, A. W., Beaty, B., Dickinson, L. M., Gurfinkel, D., Eisert, S., Roth, H., Herrero, D., Trefren, L., & Herlihy, R. (2017). Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck? Academic Pediatrics, 17(3), 330-338. https://doi.org/10.1016/j.acap.2016.11.016
Kempe A, et al. Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck. Acad Pediatr. 2017;17(3):330-338. PubMed PMID: 27913163.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck? AU - Kempe,Allison, AU - Saville,Alison W, AU - Beaty,Brenda, AU - Dickinson,L Miriam, AU - Gurfinkel,Dennis, AU - Eisert,Sheri, AU - Roth,Heather, AU - Herrero,Diana, AU - Trefren,Lynn, AU - Herlihy,Rachel, Y1 - 2016/11/29/ PY - 2016/07/25/received PY - 2016/11/22/revised PY - 2016/11/23/accepted PY - 2016/12/4/pubmed PY - 2017/12/8/medline PY - 2016/12/4/entrez KW - centralized reminder/recall KW - children KW - immunization informations systems KW - immunization registry KW - immunizations KW - novel approaches KW - population-based reminder/recall KW - reminder/recall SP - 330 EP - 338 JF - Academic pediatrics JO - Acad Pediatr VL - 17 IS - 3 N2 - OBJECTIVE: We compared the effectiveness and cost-effectiveness of: 1) centralized reminder/recall (C-R/R) using the Colorado Immunization Information System (CIIS) versus practice-based reminder/recall (PB-R/R) approaches to increase immunization rates; 2) different levels of C-R/R intensity; and 3) C-R/R with versus without the name of the child's provider. METHODS: We conducted 3 sequential cluster-randomized trials involving children aged 19 to 25 months in 15 Colorado counties in March 2013 (trial 1), October 2013 (trial 2), and May 2014 (trial 3). In C-R/R counties, the intensity of the intervention decreased sequentially in trials 1 through 3, from 3 to 1 recall messages. In PB-R/R counties, practices were offered training using CIIS and financial support. The percentage of children with up-to-date (UTD) vaccinations was compared 6 months after recall. A mixed-effects model assessed the association between C-R/R versus PB-R/R and UTD rates. RESULTS: C-R/R was more effective in trials 1 to 3 (relative risk = 1.11; 95% confidence interval 1.01-1.20; P = .009). Effectiveness did not decrease with decreasing intervention intensity (P = .59). Costs decreased with decreasing intensity in the C-R/R arm, from $18.72 per child brought UTD in trial 1 to $10.11 in trial 3. Costs were higher and more variable in the PB-R/R arm, ranging from $20.63 to $237.81 per child brought UTD. C-R/R was significantly more effective if the child's practice name was included (P < .0001). CONCLUSIONS: C-R/R was more effective and cost-effective than PB-R/R for increasing UTD rates in young children and was most effective if messages included the child's provider name. Three reminders were not more effective than one, which may be explained by the increasing accuracy of contact information in CIIS over the course of the trials. SN - 1876-2867 UR - https://www.unboundmedicine.com/medline/citation/27913163/Centralized_Reminder/Recall_to_Increase_Immunization_Rates_in_Young_Children:_How_Much_Bang_for_the_Buck L2 - https://linkinghub.elsevier.com/retrieve/pii/S1876-2859(16)30506-X DB - PRIME DP - Unbound Medicine ER -