Immunization rates improve with centralized reminder system

The study found that a centralized notification system run in collaboration with public health departments and physician practices was more effective and cost-effective than a practice-based notification system, which few practices implemented.

Reminder/recall notification systems for immunizations have been shown to be a way to help increase immunization rates. However, the use of such systems by primary care practices has been less than 20 percent nationally because of numerous barriers to implement a system that relies on phone calls and mailings, according to the study background.

Allison Kempe, MD, MPH, professor of pediatrics and director of the Children's Outcomes Research Program, and her coauthors conducted a randomized trial using the Colorado Immunization Information System (CIIS) to measure the effectiveness of a collaborative centralized (CC) system compared with a practice-based (PB) reminder/recall system. Public health entities, most pediatric practices and many family medicine practices were enrolled in CIIS, which collects vaccination data.

The study included 18,235 children (ages 19 to 35 months) in 15 Colorado counties. Patients in the CC group received autodial and mail reminders or mail reminders only. Practices in the PB group were invited to attend training on a notification system and they were offered reimbursement to help with mailing or generating phone calls.

Study results indicate that 7,873 of 9,049 (87 percent) children in the CC group received at least one contact, while in the PB group the reach was just 75 of 9,189 (0.8 percent) children because only two practices conducted reminder/recall notifications.

Documentation rates for at least one immunization were 26.9 percent for the CC group vs. 21.7 percent for the PB counties and 12.8 percent vs. 9.3 percent of patients, respectively, achieved up-to-date (UTD) status. The CC reminder/recall system was also more cost-effective.

"Our findings and those of previous studies support consideration of a CC compared with a PB reminder/recall approach to increase immunization rates during the preschool years. Sustainable funding mechanisms will be needed to support such an approach and may involve a shared investment between practice organizations or accountable care organizations and the public sector. With minimal contributions from each, substantial cost savings should be realized from a societal perspective," the study concludes.