Effect of a novel birth intervention and reminder-recall on on-time immunization compliance in high-risk children

Profound racial/ethnic immunization rate disparities exist among young children in Chicago. We created BIRTH PIP, a program combining immunization education at birth with ongoing reminder-recall, to achieve greater than 90% on-time adherence with AAP/ACIP immunization recommendations among inner-city children aged 0-35 months. The study also examines the cost of this effort.

A total of 400 neonates were enrolled. At all examined time points, on-time immunization rates exceeded city-wide data. Of those completing the program, 92% of children had 100% compliance with prescribed immunizations by 24 months. No child required follow-up past 29 months. Retention was an important problem, primarily due to pre-set eligibility requirements. Mean cost per child to complete recommended immunizations was $288. Compliant families were less expensive to maintain.

Outreach workers met with post-partum mothers who were English speaking, Chicago residents and receiving Medicaid, to provide immunization education and determine a contact strategy. Parents were reminded of each well-child appointment. Those missing appointments were re-contacted and rescheduled. Home visits were made when there was no contact by phone and mail. Enrollees and immunizations were tracked until all recommended immunizations were received. On-time immunization rates were compared with city-wide immunization data. Costs were calculated by assessing outreach worker effort and other programmatic costs.

BIRTH PIP is effective in improving immunization rates in underserved children. Economies of scale will decrease the per child cost. Preventing even a few cases of vaccine-preventable illness would likely render this initiative cost-effective.