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Strategies to improve immunization rates and well-child care in a disadvantaged population: a cluster randomized
Simon J Hambidge1, Arthur J Davidson, Stephanie L Phibbs
1Department of Pediatrics, University of Colorado Health Sciences Center, and Denver Health Medical Center, 777 Bannock Street, MC 132, Denver, CO 80204, USA. simon.hambidge@uchsc.edu
Insights
A multimodal intervention slightly increased childhood immunizations but did not significantly improve well-child care visit (WCV) or immunization rates in inner-city infants. These findings suggest limitations for certain interventions in socioeconomically disadvantaged populations.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Inner-city populations often face barriers to consistent healthcare access.
- Childhood immunizations and well-child care visits (WCVs) are crucial for developmental monitoring and disease prevention.
- Multimodal interventions aim to improve healthcare utilization in underserved communities.
Purpose of the Study:
- To evaluate the impact of a multimodal intervention on well-child care visit (WCV) and immunization rates among inner-city infants.
- To assess the effectiveness of patient- and clinic-based strategies in improving healthcare adherence.
Main Methods:
- A cluster randomized controlled trial involving 2843 infants in an integrated inner-city healthcare system.
- Eleven clinics were randomized into WCV intervention, immunization intervention, or control groups.
- Primary outcomes included up-to-date immunization and WCV status by 12 months; secondary outcomes were healthcare utilization and charges.
Main Results:
- The intervention arms showed a modest increase in immunization rates (5-6%) and WCV rates (7-8%) compared to controls.
- Multivariate analysis indicated a higher number of immunizations in the WCV arm but no significant increase in up-to-date rates for either intervention.
- No significant impact was observed on emergency, urgent care, or inpatient utilization; WCV arm had slightly higher charges.
Conclusions:
- The multimodal intervention yielded a small increase in administered immunizations but did not significantly improve up-to-date rates for WCVs or immunizations.
- Patient- and clinic-based approaches may not be universally effective in enhancing healthcare adherence in socioeconomically disadvantaged inner-city populations.
- Further research is needed to identify effective strategies for improving preventive healthcare access in vulnerable urban communities.
Objective:
To measure the effect of a multimodal intervention on well-child care visit (WCV) and immunization rates in an inner-city population.
Design:
Cluster randomized controlled trial.
Setting And Participants:
One-year cohort of 2843 infants born at a hospital in an integrated inner-city health care system.
Interventions:
Eleven clinics were randomly allocated to 1 of 3 study arms: WCV intervention (n = 3), immunization intervention (n = 4), and controls (n = 4). Interventions to improve immunization and WCV rates included both patient-based and clinic-based activities.
Main Outcome Measures:
Up-to-date status with childhood immunizations and WCVs by age 12 months (primary) and health care utilization and charges (secondary).
Results:
Compared with the control arm, the WCV and immunization arms had 5% to 6% higher immunization rates and 7% to 8% higher WCV rates. In multivariate analyses that accounted for the clustered nature of the data, the number of immunizations received was greater in the WCV arm than in controls. However, neither the WCV nor the immunization intervention increased WCV or immunization up-to-date rates. The WCV arm had slightly higher health care charges. Neither intervention affected emergency, urgent care or inpatient utilization.
Conclusions:
This multimodal intervention produced a small increase in the number of childhood immunizations delivered. However, patient- and clinic-based methods did not lead to significant increases in WCV or immunization up-to-date rates after controlling for other factors. Methods found in some settings to increase immunization up-to-date rates may not be as effective in a population of inner-city socioeconomically disadvantaged children.
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