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

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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.

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.

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.

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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