A stepped intervention increases well-child care and immunization rates in a disadvantaged population.
OBJECTIVE
To test a stepped intervention of reminder/recall/case management to increase infant well-child visits and immunization rates.


METHODS
We conducted a randomized, controlled, practical, clinical trial with 811 infants born in an urban safety-net hospital and followed through 15 months of life. Step 1 (all infants) involved language-appropriate reminder postcards for every well-child visit. Step 2 (infants who missed an appointment or immunization) involved telephone reminders plus postcard and telephone recall. Step 3 (infants still behind on preventive care after steps 1 and 2) involved intensive case management and home visitation.


RESULTS
Infants in the intervention arm, compared with control infants, had significantly fewer days without immunization coverage in the first 15 months of life (109 vs 192 days P < .01) and were more likely to have >or=5 well-child visits (65% vs 47% P < .01). In multivariate analyses, infants in the intervention arm were more likely than control infants to be up to date with 12-month immunizations and to have had >or=5 well-child visits. The cost per child was $23.30 per month.


CONCLUSIONS
This stepped intervention of tracking and case management improved infant immunization status and receipt of preventive care in a population of high-risk urban infants of low socioeconomic status.
Hambidge
Simon J
SJ
Denver Community Health Services, Denver Health, Denver,Colorado , USA 80204. simon.hambidge@dhha.org
Phibbs
Stephanie L
SL
Chandramouli
Vijayalaxmi
V
Fairclough
Diane
D
Steiner
John F
JF
D044383:Black People; D019090:Case Management / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000706:statistics & numerical data*; D003120:Colorado; D003151:Community Health Centers / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006792:House Calls; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D017010:Reminder Systems; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D035862:Vulnerable Populations; D001741:Black or African American