1. Keys to Practice-Based Immunization Recall
Sarah J. Clark, MPH
Ericka Hudson, MHSA
Kevin J. Dombkowski, DrPH
Child Health Evaluation and Research Unit (CHEAR)
University of Michigan
National Immunization Conference
April 1, 2009

2. Background
Immunization reminder/recall shown to be effective in increasing childhood immunization rates.
Identify kids who are eligible or overdue to vaccine dose(s)
Notify providers and/or parents about the need for vaccination

3. Background
BUT immunization reminder/recall is not necessarily easy. It requires:
Reliable system of identifying children’s immunization status
Personnel who know how to manipulate the system
Accurate contact information for notification targets

4. Purpose
To describe the extent to which practices are able to conduct immunization reminder/recall

5. Methods Study setting: Detroit metropolitan area
Targeted sampling to recruit a variety of practices that provide childhood immunizations
Invited to participate in an intervention to increase the use of immunization recall using the Michigan Care Improvement Registry (MCIR)

6. Study Design Participating practices were:
asked to conduct immunization recalls for month old children
provided with hands-on MCIR training and ongoing technical support
asked to conduct 4 recalls over a one year period

7. Participation Onsite training from MCIR Regional staff :
General MCIR recall training + manual
Hands-on assistance with initial set-up (e.g., building roster, running test recall)
Ongoing support
Training ranged from 30 minutes to several days
“Best-case scenario” for practice-based recall

8. Practice Characteristics
17 practices
15 private offices; 2 CHCs
13 pediatric practices; 4 family/general med
All used MCIR at study entry; all but one interfaced via high-speed internet
10 practices reported some experience with recall, typically through health plans

9. Recalls
March 2007 – May 2008:
Practices conducted a total of 56 recalls:
≥1 recall: 94% (16 of 17 practices)
≥2 recalls: 82% (14 practices)
≥3 recalls: 65% (11 practices)
≥4 recalls: 53% (9 practices)
1 practice did not conduct any recalls

10. Recalls To put it another way: 1 practice did not conduct any recalls
2 practices conducted only 1 recall
3 practices conducted only 2 recalls
2 practices conducted 3 recalls
9 practices conducted ≥4 recalls

11. WHY such variation? “If you’ve seen one practice,

12. A practice

13. A practice

14. Recall Challenges
Perceived burden of recall greater than staff availability
1 practice was trained but decided that they did not want to participate further.
Similar practices probably declined study participation altogether.
This is a significant challenge in getting in the door for practice-based recall!

15. Recall Challenges Practice disruptions
Of the 2 practices that conducted only 1 recall, one closed; the other moved to a different location.

16. Recall Challenges Issues with data accuracy
classic: accurate info in practice record, registry info not updated or incorrect

17. Recall Challenges Issues with data accuracy
classic: accurate info in practice record, registry info not updated or incorrect
high-tech: automated transfer of info from practice record to registry problematic (e.g., Pediarix)

18. Recall Challenges Issues with data accuracy
classic: accurate info in practice record, registry info not updated or incorrect
high-tech: automated transfer of info from practice record to registry problematic (e.g., Pediarix)
systemic: practice info not correct

19. Recall Challenges Exceptions Practice-specific immunization schedule
Shortage situations
Waivers

20. Recall Challenges Technical issues
minor procedural problems create temporary barriers
“learning curve”
time requirement is greater for initial recalls

21. Recall Challenges
Disconnect between recall “worker bees” and clinical providers
time commitment
perceived benefit
support for recall vs other tasks

22. Overcoming Barriers Keys to overcoming barriers Ongoing training
Ongoing technical support
Ongoing moral support

23. Future Recalls
10 practices thought they would continue registry-based recalls
most high performers
a few late bloomers
Most prefer recalls to be done at practice level

24. Future Recalls
3 practices do not plan to continue registry-based recalls
staff/time burden too high
prefer recalls to be done by health plans or health departments

25. Future Recalls 4 practices uncertain about future recall use
prefer recalls to be done by health plans, with practice to supplement

26. Summary
In this “best-case scenario” situation, about half of practices could achieve goals for recall frequency
Recall challenges should be expected, and may require substantial time to overcome

27. Summary
Some practices may not be capable of sustaining practice-based recall
Different levels of reminder/recall should be considered:
practice level
LHD/county
health plan

28. Acknowledgements MCIR regional and state staff
MDCH Immunization Division
Practice staff