BACKGROUND:
Though influenza and pneumococcal disease are leading causes of death, many primary care offices lack systems to assure the delivery of effective adult vaccines. In Rochester, NY, where previous interventions have led to relatively high overall adult vaccination rates, racial and ethnic vaccination disparities persist. A previous intervention through neighborhood health centers was successful in increasing childhood vaccination rates and decreasing disparities.

OBJECTIVE:
To test the effectiveness of office-based strategies including patient tracking, patient and provider reminder and recall, and outreach based in inner-city practices to increase rates and reduce disparities in adult vaccination.

METHOD:
Patients in 7 inner city clinics (8 locations) were randomized to control and intervention groups by the last digit of their social security or health insurance identification numbers. Pneumococcal and influenza vaccination rates for each group were determined at baseline and at follow-up intervals. The intervention consisted of a structured tracking, recall/reminder and outreach program.

RESULT:
Outcome measures include:
· The difference in pneumococcal immunization rates between the intervention and control groups (beginning and end of the project period) and these differences by race and ethnicity.
· The same measures with respect to influenza vaccination rates.

CONCLUSION:
Tracking, reminder/recall and outreach are effective in increasing rates and reducing disparities in inner-city practices and clinics. Further studies must address the sustainability of such systems.

LEARNING OBJECTIVES:
1. Describe a study design to test the effectiveness of interventions in primary care.
2. Name two limitations of this study.
3. Name two ways in which the intervention might be improved and sustained.