title: Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates.
abstract: OBJECTIVE
  To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents.
  
  
  METHODS
  Randomized clinical trial allocating adolescents (aged 11-15 years) to intervention vs standard of care control.
  
  
  METHODS
  Eight primary care practices.
  
  
  METHODS
  Population-based sample of adolescents (N = 7546).
  
  
  METHODS
  Immunization navigators at each practice implemented a tiered protocol: immunization tracking, telephone or mail reminder/recall, and home visits if participants remained unimmunized or behind on preventive care visits.
  
  
  METHODS
  Immunization rates at study end. Secondary outcomes were preventive care visit rates during the previous 12 months and costs.
  
  
  RESULTS
  The intervention and control groups were similar at baseline for demographics (mean age, 13.5 years; 63% black, 14% white, and 23% Hispanic adolescents; and 74% receiving Medicaid), immunization rates, and preventive care visit rates. Immunization rates at the end of the study were 44.7% for the intervention group and 32.4% for the control group (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.5); preventive care visit rates were 68.0% for the intervention group and 55.2% for the control group (1.2; 1.2-1.3). Findings were similar across practices, sexes, ages, and insurance providers. The number needed to treat for immunizations and preventive care visits was 9. The intervention cost was $3.81 per adolescent per month; the cost per additional adolescent fully vaccinated was $465, and the cost per additional adolescent receiving a preventive care visit was $417.
  
  
  CONCLUSIONS
  A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00581347.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. peter_szilagyi@urmc.rochester.edu
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Sarah
authors.initials: S
authors.lastname: Gallivan
authors.forename: Christina
authors.initials: C
authors.lastname: Albertin
authors.forename: Martha
authors.initials: M
authors.lastname: Sandler
authors.forename: Aaron
authors.initials: A
authors.lastname: Blumkin
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D008297:Male; D009518:New York; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D012016:Reference Values; D017010:Reminder Systems / Q000706:statistics & numerical data; D018570:Risk Assessment; D012959:Socioeconomic Factors; D059039:Standard of Care / Q000458:organization & administration; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*