Effect of a novel birth intervention and reminder-recall on on-time immunization compliance in high-risk children

 Abstract

Objectives: Profound racial/ethnic immunization rate disparities exist among young children in Chicago.  We created BIRTH PIP, a program combining immunization education at birth with ongoing reminder-recall, to achieve greater than 90% on-time adherence with AAP/ACIP immunization recommendations among inner-city children aged 0-35 months.  The study also examines the cost of this effort.


Study Design: Outreach workers met with post-partum mothers who were English speaking, Chicago residents and receiving Medicaid, to provide immunization education and determine a contact strategy.  Parents were reminded of each well-child appointment. Those missing appointments were re-contacted and rescheduled.  Home visits were made when there was no contact by phone and mail.  Enrollees and immunizations were tracked until all recommended immunizations were received.  On-time immunization rates were compared with city-wide immunization data.  Costs were calculated by assessing outreach worker effort and other programmatic costs.


Results: A total of 400 neonates were enrolled.  At all examined time points, on-time immunization rates exceeded city-wide data.  Of those completing the program, 92% of children had 100% compliance with prescribed immunizations by 24 months.  No child required follow-up past 29 months.  Retention was an important problem, primarily due to pre-set eligibility requirements.  Mean cost per child to complete recommended immunizations was $288.  Compliant families were less expensive to maintain.


Conclusions: BIRTH PIP is effective in improving immunization rates in underserved children.  Economies of scale will decrease the per child cost.  Preventing even a few cases of vaccine-preventable illness would likely render this initiative cost-effective.

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Pages
395 - 402
doi
10.4161/hv.5.6.7282
Type
Research Paper
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Effect of a novel birth intervention and reminder-recall on on-time immunization compliance in high-risk children