Improving Childhood Immunization Coverage Using a Statewide Immunization Registry

描述(由申请人提供)： 提醒/召回已被证明是提高儿童疫苗接种率的有效手段，但其使用尚未得到广泛采用。免疫接种提供者指出，认为工作人员的时间和费用是阻碍采用提醒/召回的主要因素。拟议的研究将评估集中提醒/召回干预措施的有效性，以改善密歇根州底特律市区儿童的免疫状况。干预期间将采用三种提醒/召回策略：对6个月前未接受建议接种疫苗的儿童进行7个月的召回；对所有儿童进行12个月的提醒，强调在第二年早期接种疫苗；对未获得初级免疫接种系列的儿童进行19个月的召回。对于这三种策略中的每一种，都将有一个干预臂与一个控制臂配对，作为评估提醒/召回有效性的基础。这3项战略将独立执行和评估，并在成本效益方面相互比较。 其具体目标是：1)制定集中提醒/召回干预措施，以关键年龄段为目标，纳入免疫提供者和家长的需求和偏好，并以全州范围内高功能免疫登记册的现有能力为基础；2)在疫苗接种率历来最低的大城市地区进行集中提醒/召回干预措施的随机对照试验；3)评估每项提醒/召回干预战略的成本效益，以便为今后实施集中提醒/召回系统的努力提供信息。 拟议项目的独特之处在于，它侧重于接种率低的种族和社会经济多样性的大城市地区；它有3种不同的提醒/召回战略，针对儿童疫苗接种时间表中的关键点；它既包括个性化的、以患者为导向的提醒/召回，也包括针对特定疫苗提供者的行动提示；它采用了严格的随机对照设计。拟议研究的结果将为使用免疫信息系统进行集中提醒/召回工作提供可靠的成本和效果大小估计。

DESCRIPTION (provided by applicant): Reminder/recall has been demonstrated to be an effective means of improving vaccination rates among children, yet its use has not been widely adopted. Immunization providers cite perceived staff time and cost as major factors impeding the adoption of reminder/recall. The proposed study will assess the effectiveness of a centralized reminder/recall intervention toward improving the immunization status of children in the urban area of Detroit, MI. Three reminder/recall strategies will be employed during the intervention: 7-month recall of children who are not up-to-date for vaccine recommended for receipt by six months of age; 12-month reminder for all children, to emphasize vaccination early in the second year of life; and 19-month recall of children who are not up-to-date for the primary immunization series. For each of the 3 strategies, an intervention arm will be paired with a control arm, to serve as the basis for assessment of reminder/recall effectiveness. The 3 strategies will be implemented and assessed independently, and compared to each other with regard to cost-effectiveness. The specific aims are to 1) develop a centralized reminder/recall intervention, that targets key age groups, incorporates the needs and preferences of both immunization providers and parents, and builds on existing capabilities of a high-functioning statewide immunization registry; 2) conduct a randomized controlled trial of the centralized reminder/recall intervention in a large urban area with historically low vaccination rates; and 3) evaluate the cost-effectiveness of each reminder/recall intervention strategy, to inform future efforts to implement centralized reminder/recall systems. The proposed project is unique in that it focuses on a large, racially and socioeconomically diverse, urban area with documented low vaccination rates; it features 3 different reminder/recall strategies targeted to key points in the children's vaccination schedule; it encompasses both personalized, patient-directed reminder/recall and vaccine-specific provider cues to action; and it incorporates a rigorous randomized controlled design. Results from the proposed study will provide reliable cost and effect-size estimates for the use of immunization information systems for centralized reminder/recall efforts.