Immunization recall: effectiveness and barriers to success in an urban teaching clinic.

OBJECTIVE: To examine effectiveness of immunization recall in an urban pediatric teaching clinic and to identify barriers to recall effectiveness. DESIGN: Randomized, controlled trial. Children aged 5 to 17 months who were not up to date (UTD) with recommended immunizations were identified and assigned to intervention (n = 294) or control groups (n = 309). The intervention consisted of a mailed postcard and up to 4 telephone calls. Two months after intervention, UTD status, visit, and probable missed opportunity rates were assessed. RESULTS: Of the intervention group, 30% could not be reached. In 12-month-old children in the intervention group compared with those in the control group, there was a trend toward higher UTD rates (51% vs 39%, P =.07) and a higher proportion of UTD children receiving immunizations as opposed to getting more complete documentation (25% vs 10%, P =.005). Similar differences between intervention and control children were not seen in the 7-month and 19-month age categories. More children in the intervention group had a health maintenance visit (17% vs 11%, P =.03). Of children in the intervention group who were seen when not UTD, 17 of 24 (71%) of those seen for an illness visit and 5 of 24 (21%) of those seen for health maintenance probably had missed opportunities to be immunized. CONCLUSIONS: Recall efforts were partially successful but were undermined by inability to reach the clinic population, poor documentation of immunizations, and missed opportunities.

The impact of immunization record aggregation on up-to-date rates--implications for immunization registries in rural areas.

Problems with poorly documented immunization records may be especially important in rural areas. To evaluate the potential impact of a regional registry in a rural region, this study quantified the change in documented immunization rates for nine primary care sites in rural Colorado resulting from the addition of public health department immunization clinic records. Manual chart reviews of immunization data were conducted at both private primary care and public health department sites in two geographic areas in rural Colorado. Data from private primary care sites were matched to data from the public health department sites. Immunization up-to-date (UTD) rates at each primary care site were then recalculated for 12- and 24-month-olds after including data from public health department sites. Of 1,533 children, 469 (31 percent) were given immunizations at both a private primary care and a public health department site. The UTD rate (3:2:3:2) of 12-month-olds using only data from primary care sites ranged from 32 to 79 percent. Including the public health department data increased the rates by 0 to 26 percent (mean = 11 percent) for 12-month-old children. The UTD rate of 24-month-olds (4:3:1:3 and any Hib on/after 12 months) ranged from 6 to 54 percent at the primary care sites. These rates increased by 6 to 21 percent (mean = 12 percent) when public health department data were added. This "virtual" registry combining primary care and public health department data increased calculated immunization rates at primary care sites substantially, with a range of 0 to 26 percent.

Effect of thimerosal recommendations on hospitals' neonatal hepatitis B vaccination policies.

We describe neonatal hepatitis B virus (HBV) vaccine policies in Colorado before and after thimerosal recommendations, plans for use of thimerosal-free HBV vaccine, and nurses' awareness of high-risk criteria for HBV vaccination. The results suggest that fewer neonates are receiving HBV vaccine at birth hospitals.

Barriers to enrollment in a state child health insurance program.

OBJECTIVE: To identify barriers to enrollment into Colorado's Child Health Insurance Plan (CHP+) for non-Hispanic (NH), Hispanic (H), and uninsured families. DESIGN: Telephone survey of 1) random samples of families who requested an application but did not complete it (N = 273 NH, N = 159 H) and 2) families with uninsured children identified by random-digit-dial statewide surveys (N = 165). RESULTS: Major reasons for not enrolling included 1) got other insurance (NH 16.5%; H 27.2% P <.01), 2) thought household income was too high to qualify (NH 21.0%; H 11.9% P =.01), and 3) paperwork (NH 13.4%; H 14.7%, P = NS). Of those who thought their income was too high (N = 76, 17.6%), 58.5% appeared eligible based on reported income. Of uninsured families, only 41.7% had heard of CHP+. Of those who had never applied, major remediable reasons included not knowing enough about the program (20.9%) and thinking household income was too high (9.3%). CONCLUSIONS: Effective marketing and education to increase awareness of CHP+ and ensure understanding of eligibility are critical to the success of the program.

How much does a regional immunization registry increase documented immunization rates at primary care sites in rural colorado?

OBJECTIVE: To determine increases in immunization up-to-date (UTD) rates at a rural pediatric practice with the sequential addition of records from other sites in a 2-county region. DESIGN/METHODS: UTD rates for children aged 3 months to 35 months (n = 876) were determined for the index practice and then recalculated after sequential addition of records from 1) the other private practice in the region, 2) 7 public primary care sites, and 3) 2 public health clinics in the region. RESULTS: Adding records from all sites increased documented UTD rates in the index practice from 49% to 64% at 3 months (N = 33, P = 0.025), 50% to 68% at 5 months (N = 38, P = 0.008), 28% to 45% at 7 months (N = 113, P <.01), 29% to 54% at 12 months (N = 200, P <.001), 11% to 35% at 19 months (N = 124, P <.001), and 10% to 33% at 24 months (N = 368, P <.001). CONCLUSIONS: Regional registries will be valuable tools for immunization delivery if there is an ongoing commitment to effective collection of current and historical immunization data.