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Getting Under the Hood: Exploring Issues That Affect Provider-Based Recall Using an Immunization Information System

  • Alison W. Saville
    Correspondence
    Address correspondence to Alison W. Saville, MSPH, MSW, 12477 E 19th Ave F443, Aurora, Colorado 80045.
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Karen Albright
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Carolyn Nowels
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Juliana Barnard
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Matthew F. Daley
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Shannon Stokley
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Kimberly Irby
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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  • Allison Kempe
    Affiliations
    Children’s Outcomes Research Program (Ms Saville, Ms Barnard, and Drs Albright, Daley, and Kempe), The Children’s Hospital, Denver, Colo; the Colorado Health Outcomes Research Program (Ms Saville, Ms Nowels, Ms Barnard, and Dr Albright), Department of Community and Behavioral Health, Colorado School of Public Health (Dr Albright), and the Department of Pediatrics (Drs Daley and Kempe), University of Colorado, Denver; the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Stokley); and the Colorado Immunization Information System, Immunization Program, Colorado Department of Public Health and Environment, Denver, Colo (Ms Irby)
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      Abstract

      Objective

      To assess 1) pediatric practices’ use of provider-based recall using an immunization information system 8 months after training on the recall process; 2) initiation and sustainability barriers to provider-based recall using an immunization information system; 3) strategies that facilitated recall initiation; and 4) recommendations for alternative approaches for conducting recall.

      Methods

      In 2008, 11 practices received training on the automatic recall function in the Colorado Immunization Information System (CIIS) for both infants and adolescents. The 2-hour computer-based training provided an opportunity for attendees to run real-time recall reports with CIIS staff assistance. Eight months later, key informant interviews were conducted with 24 providers and staff from these practices.

      Results

      Eight months after training, only 4 of 11 practices had implemented recall using CIIS: 3 practices recalled children ≤2 years of age, and 1 practice recalled adolescent girls for human papillomavirus vaccine. Initiation barriers included lack of awareness of baseline immunization rates, distrust in the accuracy of CIIS-generated data, and perceived difficulties recalling adolescents. Having unrealistic expectations about recall effectiveness was a barrier to sustainability. Strategies that facilitated recall included having a dedicated staff person for recall efforts and recalling children ≤2 years of age. Most key informants viewed population-based recall conducted by public health departments or schools as an acceptable alternative to provider-based recall.

      Conclusions

      Even with a promising tool to assist pediatric offices, implementing provider-based recall is challenging for pediatric practices. Given existing barriers, providers expressed support for alternative recall methods.

      Keywords

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