Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 455-464 (doi:10.1542/peds.2008-0446)
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ARTICLE

A Stepped Intervention Increases Well-Child Care and Immunization Rates in a Disadvantaged Population

Simon J. Hambidge, MD, PhDa,b,c,d, Stephanie L. Phibbs, MPHd, Vijayalaxmi Chandramouli, MSd, Diane Fairclough, DrPHd and John F. Steiner, MD, MPHd,e

a Denver Community Health Services, Denver Health, Denver, Colorado; Departments of
b Pediatrics
c Preventive Medicine and Biometrics
e General Internal Medicine
d Colorado Health Outcomes Program, University of Colorado School of Medicine, Denver, Colorado

OBJECTIVE: To test a stepped intervention of reminder/recall/case management to increase infant well-child visits and immunization rates.

METHODS: We conducted a randomized, controlled, practical, clinical trial with 811 infants born in an urban safety-net hospital and followed through 15 months of life. Step 1 (all infants) involved language-appropriate reminder postcards for every well-child visit. Step 2 (infants who missed an appointment or immunization) involved telephone reminders plus postcard and telephone recall. Step 3 (infants still behind on preventive care after steps 1 and 2) involved intensive case management and home visitation.

RESULTS: Infants in the intervention arm, compared with control infants, had significantly fewer days without immunization coverage in the first 15 months of life (109 vs 192 days P < .01) and were more likely to have ≥5 well-child visits (65% vs 47% P < .01). In multivariate analyses, infants in the intervention arm were more likely than control infants to be up to date with 12-month immunizations and to have had ≥5 well-child visits. The cost per child was $23.30 per month.

CONCLUSION: This stepped intervention of tracking and case management improved infant immunization status and receipt of preventive care in a population of high-risk urban infants of low socioeconomic status.

Key Words: child health services • community pediatrics • immunization • randomized • controlled trial • well-child care

Abbreviations: CI—confidence interval • DH—Denver Health • OR—odds ratio • WCV—well-child visit • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification

Accepted Nov 25, 2008.


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