Intervention at Birth with Ongoing Reminder Recall Dramatically Improves on-Time Immunization Compliance

Background:
The Pediatric Immunization Program (PIP) was initiated in 1993 to achieve on-time immunization in the first 2 years of life using a “reminder-recall on foot” strategy. We canvassed public housing, assessed children's immunization status, and referred infants to their medical home when delayed immunization and well child care receipt was documented. This initial approach was successful but labor-intensive. We discovered that the hepatitis B vaccine administered at birth was a positive predictor of on-time compliance in children <35 months of age. We therefore modified our approach and provided an immunization education intervention in the hospital at birth followed by reminder-recall, naming this ongoing intervention “BIRTH PIP.”

Setting:
Birthing unit, University of Chicago Medical Center, and surrounding community in the south side of Chicago.

Population:
Underserved, inner-city African-American population receiving Medicaid.

Project Description:
We conducted 3 studies (BIRTH PIP 1, 2, and 3), each enrolling 200 newborns. BIRTH PIP 1 and BIRTH PIP 2 lost more than half of enrollees due to setting too narrow a follow-up catchment area (Rule Failure) and lost contact with many enrollees (Program Failure). Nevertheless, >90% of remaining enrollees were up-to-date. BIRTH PIP 3 diminished Rule Failure by following children anywhere in Chicago. To date, all enrollees are >15 months of age. BIRTH PIP 3 has retained 92% of enrollees with 98% up-to-date.

Results/Lessons Learned:
In BIRTH PIP 3, the on-time immunization rate is still >90% with Rule Failures greatly diminished. Cost-benefit analyses revealed the less reminding a parent-child unit needed to be compliant with scheduled visits, the less expensive the BIRTH PIP intervention. In conclusion, BIRTH PIP is effective in improving on-time immunization compliance among underserved inner-city children and deserves to be tried on a larger scale.