Keys to Practice-Based Immunization Recall

Background:
Although recall has been shown to increase immunization rates, the degree to which it can be successfully conducted in the practice setting is unknown.

Objectives:
To describe the extent to which practices are able to conduct immunization recall.

Methods:
Practices in the Detroit metropolitan area were invited to participate in study of private-sector immunization recall. Recall protocols utilized the statewide Michigan Care Improvement Registry (MCIR); participating practices received training and technical support from MCIR staff. After training, practices were asked to conduct 4 recall cycles over a 12-month period; postage and mailing supplies provided by the study.

Results:
Eighteen practices (13 pediatric, 5 family medicine) agreed to participate and received training. Of these, nine practices successfully completed ≥4 recalls; two practices completed 3 recalls; and four practices completed 2 recalls. Two practices conducted only one recall, due to office relocation or closure; one practice decided after training that staffing was inadequate to conduct recall. Nearly all practices reported challenges to conducting recalls. Four practices required retraining or additional assistance from MCIR staff; one site with high turnover needed retraining three times. Children were incorrectly flagged as not up-to-date due to incomplete immunization history (nine practices) and to use of a modified immunization schedule (two practices). Other issues involved outdated address information, problems with automated transfer files, and incorrect lot numbers.

Conclusions:
Although many practices were able to conduct immunization recall, few were able to successfully sustain these efforts. Practices reported considerable needs related to training and data entry, even beyond the extensive support provided in the study. Efforts to promote practice-based immunization recall will need to incorporate extensive training and technical support.