A Stepped Intervention Increases Well-Child Care and Immunization Rates in a Disadvantaged Population

Author:

Hambidge Simon J.1234,Phibbs Stephanie L.4,Chandramouli Vijayalaxmi4,Fairclough Diane4,Steiner John F.45

Affiliation:

1. Denver Community Health Services, Denver Health, Denver, Colorado; Departments of

2. Pediatrics

3. Preventive Medicine and Biometrics

4. General Internal Medicine

5. Colorado Health Outcomes Program, University of Colorado School of Medicine, Denver, Colorado

Abstract

OBJECTIVE: To test a stepped intervention of reminder/recall/case management to increase infant well-child visits and immunization rates. METHODS: We conducted a randomized, controlled, practical, clinical trial with 811 infants born in an urban safety-net hospital and followed through 15 months of life. Step 1 (all infants) involved language-appropriate reminder postcards for every well-child visit. Step 2 (infants who missed an appointment or immunization) involved telephone reminders plus postcard and telephone recall. Step 3 (infants still behind on preventive care after steps 1 and 2) involved intensive case management and home visitation. RESULTS: Infants in the intervention arm, compared with control infants, had significantly fewer days without immunization coverage in the first 15 months of life (109 vs 192 days P < .01) and were more likely to have ≥5 well-child visits (65% vs 47% P < .01). In multivariate analyses, infants in the intervention arm were more likely than control infants to be up to date with 12-month immunizations and to have had ≥5 well-child visits. The cost per child was $23.30 per month. CONCLUSION: This stepped intervention of tracking and case management improved infant immunization status and receipt of preventive care in a population of high-risk urban infants of low socioeconomic status.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference50 articles.

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2. Centers for Disease Control and Prevention. National, state, and urban area vaccination coverage levels among children aged 19–35 months: United States, 2006. MMWR Morb Mortal Wkly Rep. 2007;56(34):880–885

3. Abramson J, Pickering L. US immunization policy. JAMA. 2002;287(4):505–509

4. National Vaccine Advisory Committee. Strategies to sustain success in childhood immunizations. JAMA. 1999;282(4):363–370

5. Gindler J, Atkinson W, Markowitz L, Hutchins S. Epidemiology of measles in the United States in 1989 and 1990. Pediatr Infect Dis J. 1992;11(10):841–846

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