BACKGROUND:
The Pennsylvania Department of Health and the Pennsylvania Chapter of the American Academy of Pediatrics' collaboration on provider immunization education stresses the need for reminder/recall systems. Available methods required considerable time on the part of practice staff members. Staff shortages magnified the difficulties with current systems. In searching for time efficient, cost effective means, the authors devised a method that utilized a birth cohort of 19 or 20 month old children and required minimal time.

OBJECTIVE:
To develop a practical reminder method that utilizes minimal staff time and limits cost to the practice. To improve 4:3:1:3:3 rate for 24 month olds in the practice.

METHOD:
A pilot study was conducted in a variety of practice settings. Each practice compiled a list of 19 or 20 month old children. Charts were reviewed to identify patients not complete for 4-3-1-3-3. These patients were then contacted by phone and/or postcard. Parameters of intervention were set by each practice based on staff availability to perform the tasks. Using this birth cohort allowed sufficient time to complete immunization by 24 months but avoided contacting children who were already complete.

RESULT:
The time taken to complete the review ranged from 45 minutes to 3 hours. All practices increased their rates. Some practices encountered obstacles that were specific to the type and location of their practice. Technical assistance was offered and provided to get the practice started and analyze systems issues. Most practices had a “hard-to-reach” group that required multiple prompts.

CONCLUSION:
Practices with low rates at the onset found this application practical, effective and usable. Practices also looked at process changes that would increase adherence to the schedule and lesson time needed for reminder systems.

LEARNING OBJECTIVES:
Identify steps necessary to implement a 19-20 month reminder system. Recognize the benefits of reminder systems.