Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates

Arch Pediatr Adolesc Med. 2011 Jun;165(6):547-53. doi: 10.1001/archpediatrics.2011.73.


Objective: To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents.

Design: Randomized clinical trial allocating adolescents (aged 11-15 years) to intervention vs standard of care control.

Setting: Eight primary care practices.

Participants: Population-based sample of adolescents (N = 7546).

Intervention: Immunization navigators at each practice implemented a tiered protocol: immunization tracking, telephone or mail reminder/recall, and home visits if participants remained unimmunized or behind on preventive care visits.

Main outcome measures: Immunization rates at study end. Secondary outcomes were preventive care visit rates during the previous 12 months and costs.

Results: The intervention and control groups were similar at baseline for demographics (mean age, 13.5 years; 63% black, 14% white, and 23% Hispanic adolescents; and 74% receiving Medicaid), immunization rates, and preventive care visit rates. Immunization rates at the end of the study were 44.7% for the intervention group and 32.4% for the control group (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.5); preventive care visit rates were 68.0% for the intervention group and 55.2% for the control group (1.2; 1.2-1.3). Findings were similar across practices, sexes, ages, and insurance providers. The number needed to treat for immunizations and preventive care visits was 9. The intervention cost was $3.81 per adolescent per month; the cost per additional adolescent fully vaccinated was $465, and the cost per additional adolescent receiving a preventive care visit was $417.

Conclusion: A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents.

Trial registration: clinicaltrials.gov Identifier: NCT00581347.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attitude to Health*
  • Child
  • Ethnicity / statistics & numerical data
  • Female
  • Health Education / organization & administration*
  • Humans
  • Immunization Programs / organization & administration*
  • Male
  • New York
  • Office Visits / statistics & numerical data
  • Primary Health Care / organization & administration
  • Primary Prevention / organization & administration*
  • Program Evaluation
  • Reference Values
  • Reminder Systems / statistics & numerical data
  • Risk Assessment
  • Socioeconomic Factors
  • Standard of Care / organization & administration
  • Urban Population
  • Vaccination / statistics & numerical data*

Associated data

  • ClinicalTrials.gov/NCT00581347