title: Effectiveness and cost of immunization recall at school-based health centers.
abstract: OBJECTIVE
  Effectiveness of recall for immunizations has not been examined in the setting of school-based health centers (SBHCs). We assessed (1) immunization rates achieved with recall among sixth-grade girls (demonstration study); (2) effectiveness of recall among sixth-grade boys (randomized controlled trial [RCT]); and (3) cost of conducting recall in SBHCs.
  
  
  METHODS
  During October 2008 through March 2009, in 4 Denver public SBHCs, we conducted (1) a demonstration study among 265 girls needing ≥ 1 recommended adolescent vaccine and (2) an RCT among 264 boys needing vaccines, with half randomized to recall and half receiving usual care. Immunization rates for recommended adolescent vaccines were assessed 6 months after recall. First dose costs were assessed by direct observation and examining invoices.
  
  
  RESULTS
  At the end of the demonstration study, 77% of girls had received ≥ 1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% (160/236) for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% (142/248) for quadrivalent meningococcal conjugate vaccine, and 59% (149/253) for the first human papillomavirus vaccine. At the end of the RCT, 66% of recalled boys had received ≥ 1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group (P < .001). Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.
  
  
  CONCLUSIONS
  SBHC-based recall was effective in improving immunization rates for all adolescent vaccines, with effects sizes exceeding those achieved with younger children in practice settings.
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, 80045, USA. allison.kempe@childrenscolorado.org
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barrow
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Alison
authors.initials: A
authors.lastname: Saville
authors.forename: Judith E
authors.initials: JE
authors.lastname: Glazner
authors.forename: Christina
authors.initials: C
authors.lastname: Suh
authors.forename: Steven
authors.initials: S
authors.lastname: Federico
authors.forename: Lisa
authors.initials: L
authors.lastname: Abrams
authors.forename: Laura
authors.initials: L
authors.lastname: Seewald
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000639:trends; D008297:Male; D022401:Meningococcal Vaccines / Q000191:economics / Q000627:therapeutic use; D053918:Papillomavirus Vaccines / Q000191:economics / Q000627:therapeutic use; D010358:Patient Participation / Q000191:economics* / Q000639:trends; D012572:School Health Services / Q000191:economics* / Q000639:trends; D013745:Tetanus Toxoid / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines; D013745:Tetanus Toxoid