title: Population-based versus practice-based recall for childhood immunizations: a randomized controlled comparative effectiveness trial.
abstract: OBJECTIVE
  We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children.
  
  
  METHODS
  This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD.
  
  
  RESULTS
  Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were $215 versus $1981 per practice and $17 versus $62 per child brought UTD.
  
  
  CONCLUSIONS
  Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Denver, CO, USA. Allison.Kempe@childrenscolorado.org
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.forename: Alison
authors.initials: A
authors.lastname: Saville
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Sheri
authors.initials: S
authors.lastname: Eisert
authors.forename: Joni
authors.initials: J
authors.lastname: Reynolds
authors.forename: Diana
authors.initials: D
authors.lastname: Herrero
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.forename: Eva
authors.initials: E
authors.lastname: Dibert
authors.forename: Vicky
authors.initials: V
authors.lastname: Koehler
authors.forename: Steven
authors.initials: S
authors.lastname: Lockhart
authors.forename: Ned
authors.initials: N
authors.lastname: Calonge
mesh_terms: D002675:Child, Preschool; D003120:Colorado; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D006801:Humans; D007114:Immunization / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D011331:Private Practice / Q000191:economics / Q000706:statistics & numerical data*; D015980:Public Health Practice / Q000191:economics / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population; D014505:Urban Population