Collaborative centralized reminder/recall notification to increase immunization rates among young children: a...

Area of Science:

• Public Health
• Health Informatics
• Pediatric Medicine

Background:

• Primary care practices often struggle to implement reminder/recall systems for childhood immunizations, with less than 20% nationally utilizing them.
• Centralized reminder/recall systems, managed by health departments in collaboration with practices, offer a potential solution to reduce practice burden, reach uninsured children, and lower costs.

Purpose of the Study:

• To compare the effectiveness and cost-effectiveness of collaborative centralized (CC) versus practice-based (PB) reminder/recall systems for childhood immunizations.
• To evaluate these approaches using the Colorado Immunization Information System (CIIS).

Main Methods:

• A randomized pragmatic trial involving 18,235 children aged 19–35 months across 15 Colorado counties.
• CC counties utilized CIIS for mail or autodialed reminders; PB counties received training and financial support for practice-led notifications.
• Primary outcome was documentation of any new immunization within 6 months; secondary outcome was achieving up-to-date (UTD) immunization status.

Main Results:

• CC reminder/recall resulted in higher rates of any new immunization (26.9% vs 21.7%) and UTD status (12.8% vs 9.3%) compared to PB methods (P < .001).
• Practice endorsement of CC notifications further enhanced effectiveness (19.2% vs 9.8% UTD status).
• CC approach was more cost-effective ($11.75 per new immunization, $24.72 per UTD status) than PB ($74.00 per immunization, $124.45 per UTD status).

Conclusions:

• Collaborative centralized reminder/recall systems are more effective and cost-effective than practice-based systems for improving childhood immunization rates.
• Practice endorsement can amplify the positive impact of centralized reminder/recall strategies.
• The modest effect size suggests ongoing evaluation and optimization of reminder/recall systems are warranted.