JAMA Pediatrics
April 2015, Vol 169, No. 4
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint | April 2015
Measles, Mandates, and Making Vaccination the Default Option
Douglas J. Opel, MD, MPH1,2; Saad B. Omer, MBBS, MPH, PhD3
Author Affiliations
JAMA Pediatr. 2015;169(4):303-304. doi:10.1001/jamapediatrics.2015.0291
Extract
This Viewpoint discusses vaccination policy and the debate between protecting individual choice and promoting public health in the context of the current measles outbreak.
The tension between individual choice and public health is both long established and enduring. It also appears to be at a breaking point. With Ebola still crisp in our collective consciousness, health care professionals, public health practitioners, and the public have been captivated by a domestic measles outbreak and confounded by the variation on this timeless tension that it embodies: more parents are exercising their choice to refuse or delay vaccination for their child, yet continued widespread acceptance of vaccination is critical to maintain herd immunity and protect the community from diseases that still circulate…

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Viewpoint | April 2015
Program Science—A Framework for Improving Global Maternal, Newborn, and Child Health
Maryanne Crockett, MD, MPH, FRCPC, DTM&H1; Lisa Avery, MD, MIH, FRCPC2; James Blanchard, MD, MPH, PhD3
Author Affiliations
JAMA Pediatr. 2015;169(4):305-306. doi:10.1001/jamapediatrics.2015.9.
Extract
In 2000, leaders from 189 countries set forth Millennium Development Goals, 2 of which focused on significant reductions in child mortality and maternal mortality by 2015. Despite substantial progress toward these goals, many countries are lagging, with increasing disparity among countries with differing resources. There is a strong consensus that much of this mortality could be prevented through the effective implementation of known evidence-based interventions.1- 3 In particular, there is evidence that the greatest effect on mortality occurs when efforts are initially focused on the most vulnerable individuals.4 Therefore, the main challenges in reducing mortality relate to how best to improve the availability, quality, and use of these critical interventions, especially for those who most need them. Meeting this challenge will require a better understanding of the distribution and configuration of health services, factors that are associated with enhancing and maintaining the quality of services, and the factors that promote and prevent use of these services along the continuum of care.5 In this regard, academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programs to improve maternal, newborn, and child health (MNCH). To fulfill this important academic mission, “science must leave the ivory tower and enter the agora,” as Gibbons urged 17 years ago.

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Editorial | April 2015
The Know, Do, and Quality Gaps in International Maternal and Child Health Care Interventions
James M. Tielsch, PhD1
Author Affiliations
JAMA Pediatr. 2015;169(4):313-314. doi:10.1001/jamapediatrics.2014.3741.
Extract
Tremendous progress has been made in reducing the mortality rates for young children, especially in low- and middle-income countries, with annual deaths down from 12.6 million in 1990 to 6.3 million in 2013.1 Although it is unlikely that number 4 (reduce child mortality) of the Millennium Development Goals set by the United Nations in 20012 will be achieved by the deadline this year, an even more ambitious goal for the elimination of preventable deaths among newborns and children younger than 5 years by 2030 is likely to be set by the United Nations General Assembly in the fall of 2015.3 Discussions about these laudable goals often center on claims such as, “we know what works, we just need to do it.” In fact, estimates of coverage of proven interventions for child survival are significantly lower than needed to maximize the effects, with the most important coverage gaps seen in the areas of family planning, interventions for newborns, and case management of childhood diseases, such as diarrhea, pneumonia, and malaria.4 This is often referred to as the know-do gap. In this issue, Mohanan et al5 provide a distressing description of this gap related to the diagnosis and treatment of diarrhea and pneumonia by health care practitioners in Bihar, India.

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The Know-Do Gap in Quality of Health Care for Childhood Diarrhea and Pneumonia in Rural India
Manoj Mohanan, PhD; Marcos Vera-Hernández, PhD; Veena Das, PhD; Soledad Giardili, MA; Jeremy D. Goldhaber-Fiebert, PhD; Tracy L. Rabin, MD; Sunil S. Raj, MD; Jeremy I. Schwartz, MD; Aparna Seth, MBA
Includes: Supplemental Content
Editorial: International Maternal and Child Health Care Gaps; James M. Tielsch, PhD

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Collaborative Centralized Reminder/Recall Notification to Increase Immunization Rates Among Young Children: A Comparative Effectiveness Trial
Allison Kempe, MD, MPH; Alison W. Saville, MSPH, MSW; L. Miriam Dickinson, PhD; Brenda Beaty, MSPH; Sheri Eisert, PhD; Dennis Gurfinkel, MPH; Sarah Brewer, MPA; Heather Shull, MA; Diana Herrero, MS; Rachel Herlihy, MD, MPH
Includes: Supplemental Content, Author Interview
Editorial: Centralized Collaborative Reminder/Recall; Alexander G. Fiks, MD, MSCE
Abstract
Importance
Reminder/recall notifications used by primary care practices increase the rates of childhood immunizations, but fewer than 20% of primary care practitioners nationally deliver such reminders. A reminder/recall notification conducted centrally by health departments in collaboration with primary care practices may reduce practice burden, reach children without a primary care practitioner, and decrease the cost of reminders/recalls.
Objective
To assess the effectiveness and cost-effectiveness of collaborative centralized (CC) vs practice-based (PB) reminder/recall approaches using the Colorado Immunization Information System (CIIS).
Design, Setting, and Participants We performed a randomized pragmatic trial from September 7, 2012, through March 17, 2013, including 18 235 children aged 19 to 35 months in 15 Colorado counties.
Interventions
In CC counties, children who needed at least 1 immunization were sent as many as 4 reminders/recalls by mail or autodialed telephone calls by the CIIS. Primary care practices in these counties were given the option of endorsing the reminder/recall notification by adding the practice name to the message. In PB counties, primary care practices were invited to web-based reminder/recall training and offered financial support for sending notifications.
Main Outcomes and Measures
Documentation of any new immunization within 6 months constituted the primary outcome; achieving up-to-date (UTD) immunization status was secondary. We assessed the cost and cost-effectiveness of each approach and used a generalized linear mixed-effects model to assess the effect of the intervention on outcomes.
Results
In PB counties, 24 of 308 primary care practices (7.8%) attended reminder/recall training and 2 primary care practices (0.6%) endorsed reminder/recall notifications. Within CC counties, 129 of 229 practices (56.3%) endorsed the reminder/recall letter. Documentation rates for at least 1 immunization were 26.9% for CC vs 21.7% for PB counties (P < .001); 12.8% vs 9.3% of patients, respectively, achieved UTD status (P  < .001). The effect of CC counties on children’s UTD status was greater when the reminder/recall notification was endorsed by the primary care practice (19.2% vs 9.8%; P < .001). The total cost of the CC reminder/recall was $28 620 or $11.75 per child for any new immunization and $24.72 per child achieving UTD status; the total cost to the 2 practices that conducted PB reminders/recalls was $74.00 per child for any immunization and $124.45 per child achieving UTD status. The modeling resulted in an adjusted odds ratio of 1.31 (95% CI, 1.16-1.48) for any new immunization in CC vs PB counties.
Conclusions and Relevance
A CC reminder/recall notification was more effective and more cost-effective than a PB system, although the effect size was modest. Endorsement by practices may further increase the effectiveness of CC reminder/recall.
Trial Registration
clinicaltrials.gov Identifier: NCT01557621