Population-based versus practice-based recall for childhood immunizations: a randomized controlled comparative effectiveness trial

Abstract

Objectives: 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.

Trial registration: ClinicalTrials.gov NCT01296906.

FIGURE 1—

CONSORT Diagram. Note. CIIS = Colorado Immunization Information System; UTD = up-to-date.

FIGURE 2—

Comparison of reach of intervention in counties that were (a) population-based and (b) practice-based. Note. Population-based counties included 188 practice sites and 12 832 children eligible for recall. Practice based counties included 195 practice sites and 18 735 children eligible for recall. ^aAssuming 100% receipt of reminder/recall. ^bAssuming 85% receipt of reminder/recall.

FIGURE 3—

Percentage brought up-to-date (UTD) of those needing vaccines at baseline.