American Journal of Public Health
Volume 103, Issue 6 (June 2013)
http://ajph.aphapublications.org/toc/ajph/current

Population-Based Versus Practice-Based Recall for Childhood Immunizations: A Randomized Controlled Comparative Effectiveness Trial
Allison Kempe, MD, MPH, Alison Saville, MSPH, MSW, L. Miriam Dickinson, PhD, Sheri Eisert, PhD, Joni Reynolds, RN, MSN, Diana Herrero, MS, Brenda Beaty, MSPH, Karen Albright, PhD, Eva Dibert, MHA, Vicky Koehler, MPH, Steven Lockhart, BA, and Ned Calonge, MD
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301035

Abstract
Objectives. We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children.

Methods. This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD.

Results. Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P  < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were $215 versus $1981 per practice and $17 versus $62 per child brought UTD.

Conclusions. Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.
Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301035