Implementing Immunization Recall in Primary Care and County Public Health Offices Using the CO Statewide Immunization Registry

Background:
Recall is an evidence based method that identifies children whose immunizations are not current and promotes bringing them into their medical home for immunizations and other care. Recall implementation and maintenance has the potential to improve medical records accuracy and tracking of the population, facilitate reporting (e.g., Vaccines for Children), decrease costs, project vaccine supply, and lead to improvements in the immunization delivery process.

Setting:
In 2006 the Colorado Immunization Information System (CIIS), Colorado Clinical Guidelines Collaborative (CCGC), and Colorado Health Outcomes (COHO) collaborated to implement and evaluate immunization recall in 11 diverse clinics and County Public Health offices in five largely rural counties in Western Colorado.

Population:
Children ages 9-10 and 19-20 months of age.

Project Description:
CCGC worked closely with each site to review their current immunization delivery process, review data quality, plan recall, develop and translate a recall notice, implement recall, train staff, and develop a sustainability plan. COHO evaluated recall implementation and sustainability in each site. In addition, CCGC completed qualitative interviews with a sample of parents and physicians about perceptions of CIIS and the use of immunization recall.

Results/Lessons Learned:
At the 6-12 month follow-up two sites had not maintained recall, three sites had low maintenance, two sites had moderate maintenance, and four sites had high maintenance. Time needed for start up will be addressed in the presentation. Immunization recall can be carried out in diverse settings by different types of staff. Data cleaning is the most time consuming and costly step but led to improvements beyond immunizations. In-person training facilitates implementation. Intensive follow-up on recall mailings was not sustainable. Feedback from parents and physicians indicated strong endorsement of a statewide immunization registry and recall. Time, staff changes, lack of consistent office systems for incorporating recall, and low yield of recall were barriers to maintenance.