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Published on: August 11, 2018
Population-based versus practice-based recall for childhood immunizations: a randomized controlled comparative
Allison Kempe1, Alison Saville, L Miriam Dickinson
1Children's Outcomes Research Program, The Children's Hospital, Denver, CO, USA. Allison.Kempe@childrenscolorado.org
Insights
Population-based recall was more effective and cost-effective for increasing preschooler immunizations compared to practice-based recall. Centralized recall significantly improved vaccination rates and documentation in children.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Medicine
Background:
- Childhood immunizations are crucial for preventing infectious diseases.
- Effective recall systems are essential for maintaining high vaccination coverage rates.
- Comparing population-based versus practice-based recall strategies can optimize public health interventions.
Purpose of the Study:
- To compare the effectiveness and cost-effectiveness of population-based recall versus practice-based recall for increasing immunizations in preschool children.
- To evaluate the impact of centralized recall using the Colorado Immunization Information System (CIIS) on vaccination status.
Main Methods:
- A cluster-randomized trial was conducted in Colorado counties involving children aged 19 to 35 months.
- Population-based recall involved central data management via CIIS.
- Practice-based recall involved training and financial support for practices to conduct their own mailings.
Main Results:
- Population-based recall resulted in a higher percentage of children up-to-date (UTD) on immunizations (18.7% vs. 12.8%) and documented vaccine receipt (31.8% vs. 22.6%) compared to practice-based recall.
- Practice-based recall had low implementation rates (5% of practices).
- Population-based recall was significantly more cost-effective, with lower costs per practice and per child brought UTD.
Conclusions:
- Centralized population-based recall is a more effective strategy for improving childhood immunization rates.
- Population-based recall demonstrates superior cost-effectiveness compared to practice-based recall for preschooler immunizations.
Objectives:
We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children.
Methods:
This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD.
Results:
Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were $215 versus $1981 per practice and $17 versus $62 per child brought UTD.
Conclusions:
Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.
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