Feasibility of initiating and sustaining registry-based immunization recall in private practices.

OBJECTIVE: To assess the feasibility of initiating and sustaining immunization recall by private practices- including the barriers and costs- using a statewide immunization information system (IIS). METHODS: Private practices in southeast Michigan were recruited in 2007 to perform IIS-based immunization recalls. Enrolled practices were provided with training and asked to conduct 4 recalls during the course of 12 months of children 19 to 35 months of age. Each practice recorded the time they spent performing recall-related activities/ labor costs were estimated. Formative and summative evaluations with semistructured interviews were conducted to identify barriers. RESULTS: Of 97 eligible pediatric and family medicine practices- 44 declined to participate- 32 did not respond to repeated contacts- and 20 agreed to enroll in the study (21%). A total of 56 recalls were conducted during the study period- with 9 practices completing at least 4 recalls and 7 practices completing 1 to 3 recalls/ 4 practices conducted no recalls. Common barriers reported included time constraints and executing all steps of the recalls. Practice costs per patient recalled ranged from \$0.05 to more than \$6 and were primarily driven by the type of personnel who performed recalls. The costs of creating a roster of current patients comprised nearly one-half of total labor costs. CONCLUSIONS: Few private provider practices that we contacted were willing to participate in this study of IIS-based recall- and less than one-half of enrolled practices completed the desired 4 recall cycles in 12 months. Time constraints and other real-world problems should not be underestimated in determining the feasibility of practice-based immunization recall. Efforts to increase the use of a statewide IIS for recall in private practice settings should emphasize ongoing training and technical support to practice staff. Improved interoperability with electronic health record systems may foster practice-based recall by reducing the labor intensity of roster building and other recall activities.