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.
Keywords
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Article Info
Publication History
Published online: November 29, 2016
Accepted:
November 23,
2016
Received:
July 25,
2016
Footnotes
Conflict of Interest: The authors declare that they have no conflict of interest.
Identification
Copyright
© 2016 by Academic Pediatric Association
