Despite abundant evidence that reminder/recall (RR) systems effectively increase immunization rates, most Arkansas health care providers in both rural and urban areas do not use them. For this reason, the Arkansas Foundation for Medical Care (AFMC) proposes to demonstrate that more Arkansas physician practices will adopt the use of recall procedures to increase childhood immunization rates if they are offered "hands on" training, together with reconfiguration of their office systems and incorporation of a consumer-driven recall methodology. This is in keeping with the commitment of the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, to achieve the Healthy People 2010 objectives in the areas of immunization and infectious diseases. The research design will test which of two options is more effective at sustaining efforts to recall patients and results in better vaccination rates: (1) a practice-based recall following intensive academic detailing, coupled with office system retooling and development of individualized business plans;or (2) access to an out-sourced Recall Center. The goal is to increase the use of recall systems in practices in various geographic regions of the state that represent populations with diverse socioeconomic characteristics. Effectiveness of the intervention will be measured by: changes in knowledge, attitudes, and practices of participating physicians (determined by pre- and post-surveys);adoption and sustainability of recall procedures;and increased vaccination rates of individual practices. It is novel because the state vaccine registry will serve as the backbone for recall efforts, with an option to be developed by the Arkansas Department of Health (ADH) to allow physicians to create their own directories within the registry, and it will employ consumer-selection of recall methods to facilitate communication with parents whose children are behind on their vaccination schedule. Further, AFMC will develop a Maintenance of Certification Quality Improvement process to incentivize physicians to adopt a recall methodology, and will consider the option of retaining the Recall Center for physicians to outsource this activity at the end of the grant period. AFMC's well-established and productive relationship with physicians in Arkansas, including an ongoing initiative to increase Arkansas well-child screening rates, and partnership with ADH, with whom it previously collaborated on an initiative to introduce Arkansas physicians to use of the vaccine registry, will facilitate all aspects of study conduct and data collection. This grant proposal is a natural extension of existing programs. Relevance: Access to an out-sourced centralized recall service will provide a useful comparison and potential alternative to in-house office practices. The knowledge gained regarding factors necessary for private providers to adopt and sustain client recall interventions, whether or not they offer vaccinations in their office, will ultimately be translatable to other state systems and have a profound positive impact on public health.
Vaccine preventable diseases result in increased numbers of doctor's visits and hospitalizations and increased lost time from work for parents of sick children. However; every $1.00 spent on childhood immunization saves $16.50 and; ''for each birth cohort who receives seven of the vaccines...given as part of the routine childhood immunization schedule; society saves $9.9 million in direct health care costs; 33;000 lives are saved; and 14 million cases of disease are prevented.'' In other words; immunization has also proven to be one of the most cost-effective of public health interventions.