Population-Based Versus Practice-Based Recall for Childhood Immunizations: A Randomized Controlled Comparative Effectiveness Trial
Population-Based Versus Practice-Based Recall for Childhood Immunizations: A Randomized Controlled Comparative Effectiveness Trial
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DOI：
10.2105/ajph.2012.301035
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发表时间：
2013-06-01
影响因子：
12.7
通讯作者：
Calonge, Ned
中科院分区：
文献类型：
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作者：
Kempe, Allison;Saville, Alison;Calonge, Ned
目标。我们比较了以人群为基础的召回（Pop-recall）和以实践为基础的召回（cpp -recall）在提高学龄前儿童免疫接种方面的有效性和成本效益。这项集群随机试验涉及科罗拉多州8个农村县和6个城市县需要免疫接种的19至35个月的儿童。在流行召回县，使用科罗拉多州免疫信息系统（CIIS）集中进行召回。在cpp召回县，实践被邀请参加使用CIIS的网络研讨会培训，并为邮件提供财政支持。在召回后6个月比较最新（UTD）和疫苗文件的百分比。一个混合效应模型评估了干预与儿童是否成为utd之间的关系。195个实践中有10个（5%）在cpp召回县实施了召回。在需要免疫接种的儿童中，pop召回县发生UTD的比例为18.7%，而pcp召回县为12.8% (P < 0.001)；在Pop-recall县，有31.8%的人接受了一种或更多疫苗，而在cpp -recall县，有22.6%的人接受了一种或更多疫苗（P < 0.001）。多变量模型的相对风险估计为，罹患UTD的风险为1.23(95%可信区间[CI] = 1.10, 1.37)，接种任何疫苗的风险为1.26 （95% CI = 1.15, 1.38）。Pop-recall和PCP-recall的成本分别为215美元和1981美元，17美元和62美元。集中开展以人群为基础的召回在提高学龄前儿童免疫接种率方面更为有效和具有成本效益。
Objectives. We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children.Methods. This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD.Results. Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were $ 215 versus $ 1981 per practice and $ 17 versus $ 62 per child brought UTD.Conclusions. Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.