title: Impact of appointment reminders on vaccination coverage at an urban clinic.
abstract: OBJECTIVE
  To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates. Design. Controlled trial.
  
  
  METHODS
  Pediatric clinic serving a low-income community in New York City.
  
  
  METHODS
  Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n = 314); telephone call (n = 307); and postcard and telephone call (n = 306).
  
  
  METHODS
  Kept-appointment and vaccination coverage rates.
  
  
  RESULTS
  Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95% CI = 1.7, 3.2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment (chi(2) = 11.2). The cost of the reminders was $.67 for the postcard and $1.58 for the postcard and telephone. Assuming 5000 visits per year and $100 reimbursement per visit, the return on each dollar invested was $10 for the postcard and $7.28 for the postcard and telephone reminder.
  
  
  CONCLUSIONS
  Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date.appointment reminder, vaccination coverage.
authors.affiliation: Division of General Pediatrics, College of Physicians and Surgeons. mi5@columbia.edu
authors.forename: M M
authors.initials: MM
authors.lastname: Irigoyen
authors.forename: S
authors.initials: S
authors.lastname: Findley
authors.forename: B
authors.initials: B
authors.lastname: Earle
authors.forename: K
authors.initials: K
authors.lastname: Stambaugh
authors.forename: R
authors.initials: R
authors.lastname: Vaughan
mesh_terms: D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011177:Postal Service; D017010:Reminder Systems / Q000191:economics; D013689:Telephone; D019037:Urban Health Services; D014611:Vaccination / Q000706:statistics & numerical data*