miércoles, 4 de enero de 2017

Centralized Reminder/Recall to Increase immunization Rates in Young Children: How Much Bang for the Buck? - PubMed - NCBI

2016 Nov 29. pii: S1876-2859(16)30506-X. doi: 10.1016/j.acap.2016.11.016. [Epub ahead of print]

Centralized Reminder/Recall to Increase immunization Rates in Young Children: How Much Bang for the Buck?

Kempe A1, Saville AW2, Beaty B2, Dickinson LM3, Gurfinkel D2, Eisert S4, Roth H5, Herrero D5, Trefren L5, Herlihy R5.

Author information

Abstract

OBJECTIVES:

We compared 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 19-25 months in 15 Colorado counties in 3/2013 (trial 1), 10/2013 (trial 2), and 5/2014 (trial 3). In C-R/R counties, the intensity of the intervention decreased sequentially in trials 1-3, from 3 to 1 recall messages. In PB-R/R counties, practices were offered training using CIIS and financial support. The percentage up-to-date (UTD) was compared 6 months after recall. A mixed-effects model assessed the association between C-R/R vs PB-R/R and UTD rates.

RESULTS:

C-R/R was more effective in Trials 1-3 [RR=1.11 (95% CI=1.01 to 1.20), p=.009]. Effectiveness did not decrease with decreasing intervention intensity (p=0.59). 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's name was included (p<.0001).

CONCLUSION:

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's name. Three reminders were not more effective than one, which may be explained by increasing accuracy of contact information in CIIS over the course of the trials.