A Stepped Intervention Increases Well-Child Care and Immunization Rates in a Disadvantaged Population

OBJECTIVE: To test a stepped intervention of reminder/ recall/ case management to increase infant well-child visits and immunization rates. METHODS: We conducted a randomized, controlled, practical, clinical trial with 811 infants born in an urban safety-net hospital and followed through 15 months of life. Step 1 (all infants) involved language-appropriate reminder postcards for every well-child visit. Step 2 (infants who missed an appointment or immunization) involved telephone reminders plus postcard and telephone recall. Step 3 (infants still behind on preventive care after steps 1 and 2) involved intensive case management and home visitation. RESULTS: Infants in the intervention arm, compared with control infants, had significantly fewer days without immunization coverage in the first 15 months of life (109 vs 192 days P < .01) and were more likely to have >= 5 well-child visits (65% vs 47% P < .01). In multivariate analyses, infants in the intervention arm were more likely than control infants to be up to date with 12-month immunizations and to have had >= 5 well-child visits. The cost per child was $23.30 per month. CONCLUSION: This stepped intervention of tracking and case management improved infant immunization status and receipt of preventive care in a population of high-risk urban infants of low socioeconomic status. Pediatrics 2009; 124: 455-464