title: Direct messaging to parents/guardians to improve adolescent immunizations.
abstract: OBJECTIVE
  To study the impact on adolescent immunization rates of direct messages to parents/guardians.
  
  
  METHODS
  Electronic health record rules identified adolescents needing an immunization. Parents/guardians of adolescents were messaged via a single vendor using automated text, prerecorded voice, and/or postcard.
  
  
  RESULTS
  Parents/guardians of 3,393 patients, ages 11-18 years, with one or more primary care visits in the prior 2 years, identified as needing (average of 2.04 years) a vaccination (meningococcal conjugate, human papillomavirus, or tetanus, diphtheria, and pertussis vaccines) were messaged (mean age, 14 years; 50% male; 38% African-American; 23% white; 19% Hispanic; and 79% public health insurance). A total of 7,094 messages were sent: 3,334 automated voice (47%), 2,631 texts (37%), and 1,129 postcards (16%). After the first message, 865 adolescents (25.5%) received at least one vaccine. Within 24 weeks of messaging 1,324 vaccines (745 human papillomavirus; 403 meningococcal conjugate; and 176 tetanus, diphtheria, and pertussis vaccines) occurred in 959 visits (83.8% physician visits and 16.2% nurse visits). Average visits generated $204 gross reimbursement for $1.77 in messaging expenses per vaccine given. No differences in immunization completion rates occurred by age, gender, race/ethnicity, or insurance type. At 24 weeks, one message was more effective than two or three messages (35.6%, 19.4%, and 24.1% effectiveness, respectively; p < .0001). Texts and postcards correlated with more vaccination visits (38.8% and 40.1%, respectively) than phone calls (31.5%; p = .04). More vaccines due led to increasing message effectiveness.
  
  
  CONCLUSIONS
  Automated texts, voice messages, and postcards had a significant positive effect on vaccination rates in adolescents needing vaccination and required minimal financial expenditure.
authors: Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.
authors: David S
authors: DS
authors: Bar-Shain
authors: Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
authors: Margaret M
authors: MM
authors: Stager
authors: Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.
authors: Anne P
authors: AP
authors: Runkle
authors: Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.
authors: Janeen B
authors: JB
authors: Leon
authors: Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio; Department of Biostatistics and Epidemiology, Case Western Reserve University, Cleveland, Ohio; Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio. Electronic address: David.kaelber@case.edu.
authors: David C
authors: DC
authors: Kaelber
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics; D002648:Child; D057286:Electronic Health Records; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D008297:Male; D010290:Parents / Q000193:education*; D011177:Postal Service; D011634:Public Health / Q000191:economics / Q000379:methods; D013685:Telecommunications; D060145:Text Messaging; D014611:Vaccination
keywords: Adolescent immunizations; Automated postcards; Automated telephone calls; Automated texting; Electronic health record; Immunization reminders