title: Collaborative centralized reminder/recall notification to increase immunization rates among young children: a comparative effectiveness trial.
abstract: OBJECTIVE
  Reminder/recall notifications used by primary care practices increase the rates of childhood immunizations, but fewer than 20% of primary care practitioners nationally deliver such reminders. A reminder/recall notification conducted centrally by health departments in collaboration with primary care practices may reduce practice burden, reach children without a primary care practitioner, and decrease the cost of reminders/recalls.
  
  
  OBJECTIVE
  To assess the effectiveness and cost-effectiveness of collaborative centralized (CC) vs practice-based (PB) reminder/recall approaches using the Colorado Immunization Information System (CIIS).
  
  
  METHODS
  We performed a randomized pragmatic trial from September 7, 2012, through March 17, 2013, including 18,235 children aged 19 to 35 months in 15 Colorado counties.
  
  
  METHODS
  In CC counties, children who needed at least 1 immunization were sent as many as 4 reminders/recalls by mail or autodialed telephone calls by the CIIS. Primary care practices in these counties were given the option of endorsing the reminder/recall notification by adding the practice name to the message. In PB counties, primary care practices were invited to web-based reminder/recall training and offered financial support for sending notifications.
  
  
  METHODS
  Documentation of any new immunization within 6 months constituted the primary outcome; achieving up-to-date (UTD) immunization status was secondary. We assessed the cost and cost-effectiveness of each approach and used a generalized linear mixed-effects model to assess the effect of the intervention on outcomes.
  
  
  RESULTS
  In PB counties, 24 of 308 primary care practices (7.8%) attended reminder/recall training and 2 primary care practices (0.6%) endorsed reminder/recall notifications. Within CC counties, 129 of 229 practices (56.3%) endorsed the reminder/recall letter. Documentation rates for at least 1 immunization were 26.9% for CC vs 21.7% for PB counties (P < .001); 12.8% vs 9.3% of patients, respectively, achieved UTD status (P < .001). The effect of CC counties on children's UTD status was greater when the reminder/recall notification was endorsed by the primary care practice (19.2% vs 9.8%; P < .001). The total cost of the CC reminder/recall was $28 620 or $11.75 per child for any new immunization and $24.72 per child achieving UTD status; the total cost to the 2 practices that conducted PB reminders/recalls was $74.00 per child for any immunization and $124.45 per child achieving UTD status. The modeling resulted in an adjusted odds ratio of 1.31 (95% CI, 1.16-1.48) for any new immunization in CC vs PB counties.
  
  
  CONCLUSIONS
  A CC reminder/recall notification was more effective and more cost-effective than a PB system, although the effect size was modest. Endorsement by practices may further increase the effectiveness of CC reminder/recall.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01557621.
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora2Department of Pediatrics, University of Colorado, Denver.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Saville
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora3Colorado Health Outcomes Program, University of Colorado, Denver4Department of Family Medicine, University of Colorado, Denver.
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora3Colorado Health Outcomes Program, University of Colorado, Denver.
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.affiliation: Department of Health Policy and Management, University of South Florida, Tampa6Department of Pediatrics, University of South Florida, Tampa.
authors.forename: Sheri
authors.initials: S
authors.lastname: Eisert
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora.
authors.forename: Dennis
authors.initials: D
authors.lastname: Gurfinkel
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, Aurora.
authors.forename: Sarah
authors.initials: S
authors.lastname: Brewer
authors.affiliation: Colorado Immunization and Information System, Colorado Department of Public Health and Environment, Denver.
authors.forename: Heather
authors.initials: H
authors.lastname: Shull
authors.affiliation: Colorado Immunization and Information System, Colorado Department of Public Health and Environment, Denver.
authors.forename: Diana
authors.initials: D
authors.lastname: Herrero
authors.affiliation: Colorado Immunization and Information System, Colorado Department of Public Health and Environment, Denver.
authors.forename: Rachel
authors.initials: R
authors.lastname: Herlihy
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; D011320:Primary Health Care / Q000191:economics*; D017010:Reminder Systems / Q000191:economics*