Allison Kempe1, Alison W Saville2, Brenda Beaty2, L Miriam Dickinson3, Dennis Gurfinkel2, Sheri Eisert4, Heather Roth5, Diana Herrero5, Lynn Trefren5, Rachel Herlihy5. 1. 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. 2. 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. 3. 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. 4. Department of Health Policy and Management and Department of Pediatrics, University of South Florida, Tampa, Fla. 5. Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
RCT Entities:
OBJECTIVE: 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. METHODS: 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. RESULTS: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). CONCLUSIONS: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: Peter G Szilagyi; Christina S Albertin; Alison W Saville; Rebecca Valderrama; Abigail Breck; Laura Helmkamp; Xinkai Zhou; Sitaram Vangala; L Miriam Dickinson; Chi-Hong Tseng; Jonathan D Campbell; Melanie D Whittington; Heather Roth; Cynthia M Rand; Sharon G Humiston; Dina Hoefer; Allison Kempe Journal: J Pediatr Date: 2020-06 Impact factor: 4.406
Authors: Peter Szilagyi; Christina Albertin; Dennis Gurfinkel; Brenda Beaty; Xinkai Zhou; Sitaram Vangala; John Rice; Jonathan D Campbell; Melanie D Whittington; Rebecca Valderrama; Abigail Breck; Heather Roth; Megan Meldrum; Chi-Hong Tseng; Cynthia Rand; Sharon G Humiston; Stanley Schaffer; Allison Kempe Journal: Pediatrics Date: 2020-04-06 Impact factor: 7.124
Authors: Jennifer C Spencer; Noel T Brewer; Justin G Trogdon; Morris Weinberger; Tamera Coyne-Beasley; Stephanie B Wheeler Journal: Pediatrics Date: 2020-11-16 Impact factor: 7.124
Authors: Laura P Hurley; Brenda Beaty; Steven Lockhart; Dennis Gurfinkel; L Miriam Dickinson; Heather Roth; Allison Kempe Journal: Prev Med Rep Date: 2019-05-22
Authors: Alison W Saville; Dennis Gurfinkel; Brenda L Beaty; Alison E Chi; Amanda Dayton; Laura Hurley; Krithika Suresh; Allison Kempe Journal: Prev Med Rep Date: 2020-12-29
Authors: Julie C Jacobson Vann; Robert M Jacobson; Tamera Coyne-Beasley; Josephine K Asafu-Adjei; Peter G Szilagyi Journal: Cochrane Database Syst Rev Date: 2018-01-18
Authors: Peter G Szilagyi; Christina S Albertin; Alejandra Casillas; Rebecca Valderrama; O Kenrik Duru; Michael K Ong; Sitaram Vangala; Chi-Hong Tseng; Sharon G Humiston; Sharon Evans; Michael Sloyan; Jonathan E Bogard; Craig R Fox; Carlos Lerner Journal: J Gen Intern Med Date: 2021-09-01 Impact factor: 5.128