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RCT of Centralized Vaccine Reminder/Recall for Adults

  • Laura P. Hurley
    Correspondence
    Address correspondence to: Laura Hurley, MD, MPH, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, 13199 East Montview Blvd., Suite 300, Aurora CO 80045.][issn]/$36#36.00$06#?>$^doi_string?>
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado

    Division of General Internal Medicine, Denver Health, Denver, Colorado
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  • Brenda Beaty
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado

    Department of Biostatistics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
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  • Steven Lockhart
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
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  • Dennis Gurfinkel
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
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  • Kristin Breslin
    Affiliations
    Ambulatory Care Services Data and Analytics, Denver Health, Denver, Colorado
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  • Miriam Dickinson
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado

    Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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  • Melanie D. Whittington
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado

    Department of Clinical Pharmacy, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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  • Heather Roth
    Affiliations
    Colorado Department of Public Health and Environment, Denver, Colorado
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  • Allison Kempe
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado

    Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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      Introduction

      A proven, but underutilized, method to increase current low vaccination rates is reminder/recall. Centralized reminder/recall using an Immunization Information System reduces the burden of an individual practice conducting reminder/recall. The objectives were to assess the effectiveness of centralized vaccine reminder/recall on improving adult vaccination rates using Colorado’s Immunization Information System.

      Study design

      This study is a pragmatic RCT.

      Setting/participants

      Denver Health patients were divided into three strata: 25,039 individuals aged 19–64 years without a high-risk condition for pneumococcal disease, 16,897 individuals aged 19–64 years with a high-risk condition, and 5,332 individuals aged ≥65 years. Data were collected from October 2015 to April 2016 and analyzed between September 2016 and June 2017.

      Intervention

      Adults aged 19–64 years without a high-risk condition who needed influenza or tetanus, diphtheria, acellular pertussis vaccine or both, and adults with a high-risk condition and adults aged ≥65 years who needed influenza, or tetanus, diphtheria, acellular pertussis, or pneumococcal vaccine, or all three vaccines were randomized to receive up to three reminder/recalls or usual care.

      Main outcome measures

      Documentation of receipt of any needed vaccine in Immunization Information System ≤6 months after the reminder/recall was the primary outcome. A secondary outcome included implementation costs of the reminder/recall effort. A mixed effects model assessed the association between the intervention and receipt of any needed vaccine while controlling for gender, age, race, ethnicity, insurance type, and history of vaccine refusal.

      Results

      The intervention was associated with receipt of any needed vaccine in the adults aged ≥65 years population (AOR=1.15, 95% CI=1.02, 1.30), but not the other two populations. Influenza vaccine was the source of this difference, with 32.0% receiving a vaccine in intervention versus 28.6% in usual-care groups (p≤0.01). Start-up and implementation costs per person were $0.86. In the population aged ≥65 years, 29.4 patients would need to be contacted to gain one additional vaccination.

      Conclusions

      Centralized reminder/recall was effective at increasing influenza vaccination rates in adults aged ≥65 years over a short time period, without burdening the practices, and at a reasonable cost.

      Trial Registration

      This study is registered at www.clinicaltrials.gov NCT02133391.
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