title: Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck?
abstract: We compared the effectiveness and cost-effectiveness of: 1) centralized reminder/recall (C-R/R) using the Colorado Immunization Information System (CIIS) versus practice-based reminder/recall (PB-R/R) approaches to increase immunization rates; 2) different levels of C-R/R intensity; and 3) C-R/R with versus without the name of the child's provider.
  
  
  
  We conducted 3 sequential cluster-randomized trials involving children aged 19 to 25 months in 15 Colorado counties in March 2013 (trial 1), October 2013 (trial 2), and May 2014 (trial 3). In C-R/R counties, the intensity of the intervention decreased sequentially in trials 1 through 3, from 3 to 1 recall messages. In PB-R/R counties, practices were offered training using CIIS and financial support. The percentage of children with up-to-date (UTD) vaccinations was compared 6 months after recall. A mixed-effects model assessed the association between C-R/R versus PB-R/R and UTD rates.
  
  
  
  C-R/R was more effective in trials 1 to 3 (relative risk = 1.11; 95% confidence interval 1.01-1.20; P = .009). Effectiveness did not decrease with decreasing intervention intensity (P = .59). Costs decreased with decreasing intensity in the C-R/R arm, from $18.72 per child brought UTD in trial 1 to $10.11 in trial 3. Costs were higher and more variable in the PB-R/R arm, ranging from $20.63 to $237.81 per child brought UTD. C-R/R was significantly more effective if the child's practice name was included (P < .0001).
  
  
  
  C-R/R was more effective and cost-effective than PB-R/R for increasing UTD rates in young children and was most effective if messages included the child's provider name. Three reminders were not more effective than one, which may be explained by the increasing accuracy of contact information in CIIS over the course of the trials.
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, Colo. Electronic address: allison.kempe@childrenscolorado.org.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Saville
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo.
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo; Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, Colo.
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo.
authors.forename: Dennis
authors.initials: D
authors.lastname: Gurfinkel
authors.affiliation: Department of Health Policy and Management and Department of Pediatrics, University of South Florida, Tampa, Fla.
authors.forename: Sheri
authors.initials: S
authors.lastname: Eisert
authors.affiliation: Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.
authors.forename: Heather
authors.initials: H
authors.lastname: Roth
authors.affiliation: Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.
authors.forename: Diana
authors.initials: D
authors.lastname: Herrero
authors.affiliation: Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.
authors.forename: Lynn
authors.initials: L
authors.lastname: Trefren
authors.affiliation: Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.
authors.forename: Rachel
authors.initials: R
authors.lastname: Herlihy
mesh_terms: D002675:Child, Preschool; D003120:Colorado; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007114:Immunization / Q000191:economics*; D017589:Immunization Programs / Q000191:economics* / Q000379:methods; D007223:Infant; D008297:Male; D017010:Reminder Systems / Q000191:economics*; D000073887:Vaccination Coverage
keywords: centralized reminder/recall; children; immunization informations systems; immunization registry; immunizations; novel approaches; population-based reminder/recall; reminder/recall