Eugene F. Dini

The Impact of Computer-Generated Messages on Childhood Immunization Coverage

Introduction: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life.Design: Randomized, controlled trial.Setting: County health department in the Denver metropolitan area.Study Participants: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines.Intervention: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s).Main Outcome Measure: Immunization series completion at 24 months of age.Results: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = 1.21; CI [confidence interval] =1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was

Information as intervention: how Georgia used vaccination coverage data to double public sector vaccination coverage in seven years.

226 (

The impact of computer-generated messages on childhood immunization coverage21In the article entitled “The Impact of Computer-Generated Messages on Childhood Immunization Coverage” by Eugene F. Dini et al., several errors occurred. Below is the text as it should have appeared. COMP: p/u from article 319, see hard copy22Publisher’s note: The publisher regrets the errors in the text.

79 after start-up costs were discounted). Conclusion: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

THE IMPACT OF OUTREACH ON IMMUNIZATION LEVELS IN INNER CITY PRESCHOOLERS.|[dagger]| 628

All states are now required by federal law to measure immunization coverage in each public clinic in their jurisdiction once a year. This law is based on data suggesting a twofold increase of immunization coverage in public clinics in Georgia during a seven-year period when the state developed a system for measuring clinic coverage and using these data to stimulate immunization performance. Review of the history of the development of the Georgia system suggests that measurement alone is not sufficient to raise coverage, however. In Georgia, measurement was coupled with a vigorous program of feedback of coverage data, provision of incentives for good performance, and exchange of information among clinics. The Centers for Disease Control and Prevention (CDC) has summarized the Georgia system with the acronym AFIX--Assessment, Feedback, Incentives, eXchange of information--and recommends that all state immunization program managers test and adapt this methodology. The article comments on the development of the Georgia system and describes why CDC believes other states should adopt it.

A Randomized Trial of the Effectiveness of Computer-Generated Telephone Messages in Increasing Immunization Visits Among Preschool Children

INTRODUCTION Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life. DESIGN Randomized, controlled trial. SETTING County health department in the Denver metropolitan area. STUDY PARTICIPANTS Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines. INTERVENTION Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s). MAIN OUTCOME MEASURE Immunization series completion at 24 months of age. RESULTS Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = .21; CI [confidence interval] = 1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was

Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994.

226 (

Effectiveness of Computer-Generated Telephone Messages in Increasing Clinic Visits

79 after start-up costs were discounted). CONCLUSION Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

Changes in Clinic Vaccination Coverage After Institution of Measurement and Feedback in 4 States and 2 Cities

Background: In 1992-3, in addition to general efforts to raise immunization coverage, CDC & GA DPH sponsored a special

The Impact of Interventions by a Community-Based Organization on Inner-city Vaccination Coverage: Fulton County, Georgia, 1992-1993

400,000 targeted outreach program to raise immunization levels in selected preschool populations within inner city Atlanta. Interventions: (1) Community-based: mobile vans, vaccination stations, door-to-door educational campaigns, and hiring of local community leaders. (2) Provider-based: reminder-recall to parents for vaccination visits in local clinics based on known vaccination status of children who had previously visited the clinics.Objective/Methods: To determine intervention impact by before-and-after assessment of documented vaccination levels among children<25 mos in intervention sites compared to control communities/clinics matched on ethnicity and SES. Results: TableConclusions: Community immunization levels improved significantly in both intervention and control communities; community-based interventions had no apparent effect on vaccination levels compared to controls. Provider-based reminder-recall to parents had positive impact compared to controls. Concurrent controls are needed to determine impact of population-based interventions.