Population-based versus practice-based recall for childhood immunizations: a randomized controlled comparative effectiveness trial.

OBJECTIVES: We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children. METHODS: This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties- recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties- practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD. RESULTS: Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations- 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001)/ 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval CI = 1.10- 1.37) for becoming UTD and 1.26 (95% CI = 1.15- 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were \$215 versus \$1981 per practice and \$17 versus \$62 per child brought UTD. CONCLUSIONS: Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.