The impact of computer-generated messages on childhood immunization coverage.

INTRODUCTION Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life. DESIGN Randomized, controlled trial. SETTING County health department in the Denver metropolitan area. STUDY PARTICIPANTS Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines. INTERVENTION Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s). MAIN OUTCOME MEASURE Immunization series completion at 24 months of age. RESULTS Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = .21; CI [confidence interval] = 1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was $226 ($79 after start-up costs were discounted). CONCLUSION Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

[1]  W. Orenstein,et al.  Barriers to Vaccinating Preschool Children , 2010, Journal of health care for the poor and underserved.

[2]  S. Humiston,et al.  Immunization practices of primary care practitioners and their relation to immunization levels. , 1994, Archives of pediatrics & adolescent medicine.

[3]  E. Lewis,et al.  Computer-generated recall letters for underimmunized children: how cost-effective? , 1997, The Pediatric infectious disease journal.

[4]  V. Dietz,et al.  Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994. , 1997, JAMA.

[5]  R. Linkins,et al.  A randomized trial of the effectiveness of computer-generated telephone messages in increasing immunization visits among preschool children. , 1994, Archives of pediatrics & adolescent medicine.

[6]  C. Lebaron,et al.  Information as intervention: how Georgia used vaccination coverage data to double public sector vaccination coverage in seven years. , 1996, Journal of public health management and practice : JPHMP.

[7]  R. Linkins,et al.  Effectiveness of computer-generated telephone messages in increasing clinic visits. , 1995, Archives of pediatrics & adolescent medicine.

[8]  T. Lieu,et al.  Effectiveness and Cost-effectiveness of Letters, Automated Telephone Messages, or Both for Underimmunized Children in a Health Maintenance Organization , 1998, Pediatrics.

[9]  A. Hinman What will it take to fully protect all American children with vaccines? , 1991, American journal of diseases of children.

[10]  G. Birkhead,et al.  The immunization of children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC). The impact of different strategies. , 1995, JAMA.

[11]  Effectiveness of computer-generated appointment reminders. , 1991, Pediatrics.

[12]  M. Lindegren,et al.  Evaluation of telephoned computer-generated reminders to improve immunization coverage at inner-city clinics. , 1993, Public health reports.

[13]  S. Stokley,et al.  Assessing Immunization Performance of Private Practitioners in Maine: Impact of the Assessment, Feedback, Incentives, and Exchange Strategy , 1999, Pediatrics.

[14]  V. Dietz,et al.  Vaccination practices, policies, and management factors associated with high vaccination coverage levels in Georgia public clinics. Georgia Immunization Program Evaluation Team. , 2000, Archives of pediatrics & adolescent medicine.