Effect of a novel birth intervention and reminder-recall on on-time immunization compliance in high-risk children

Hum Vaccin. 2009 Jun;5(6):395-402. doi: 10.4161/hv.5.6.7282. Epub 2009 Jun 28.


Objectives: Profound racial/ethnic immunization rate disparities exist among young children in Chicago. We created BIRTH PIP, a program combining immunization education at birth with ongoing reminder-recall, to achieve greater than 90% on-time adherence with AAP/ACIP immunization recommendations among inner-city children aged 0-35 months. The study also examines the cost of this effort.

Results: A total of 400 neonates were enrolled. At all examined time points, on-time immunization rates exceeded city-wide data. Of those completing the program, 92% of children had 100% compliance with prescribed immunizations by 24 months. No child required follow-up past 29 months. Retention was an important problem, primarily due to pre-set eligibility requirements. Mean cost per child to complete recommended immunizations was $288. Compliant families were less expensive to maintain.

Study design: Outreach workers met with post-partum mothers who were English speaking, Chicago residents and receiving Medicaid, to provide immunization education and determine a contact strategy. Parents were reminded of each well-child appointment. Those missing appointments were re-contacted and rescheduled. Home visits were made when there was no contact by phone and mail. Enrollees and immunizations were tracked until all recommended immunizations were received. On-time immunization rates were compared with city-wide immunization data. Costs were calculated by assessing outreach worker effort and other programmatic costs.

Conclusions: BIRTH PIP is effective in improving immunization rates in underserved children. Economies of scale will decrease the per child cost. Preventing even a few cases of vaccine-preventable illness would likely render this initiative cost-effective.

MeSH terms

  • Chicago
  • Child, Preschool
  • Female
  • Health Services Research*
  • Humans
  • Immunization Programs*
  • Immunization Schedule*
  • Infant
  • Infant, Newborn
  • Mothers
  • Patient Compliance / statistics & numerical data*
  • Reminder Systems / economics*
  • Vaccination / statistics & numerical data*