Irigoyen Matilde M, Findley Sally, Wang Dongwen, Chen Shaofu, Chimkin Frank, Pena Oscar, Mendonca Eneida
Children's Hospital of New York Presbyterian, NY, USA.
Ambul Pediatr. 2006 Mar-Apr;6(2):100-4. doi: 10.1016/j.ambp.2005.10.006.
To assess the effectiveness of two serial registry reminder protocols and the interactive effects of reminders with child characteristics on immunization rates.
At an inner city practice network in New York City we randomized 1662 children aged 6 weeks-15 months due or late for a diphtheria-tetanus-pertussis (DTaP) to 3 groups: continuous reminders (as needed), limited reminders (up to 3) and controls, for 6 months. Reminders were triggered by the hospital registry and immunizations were tracked with both the hospital and city registries. Analyses were based on intention to treat.
At randomization, the study groups were comparable (9.2 months of age, 77% Latino, 86% Medicaid, 49.3% up-to date). A quarter of the children were sent false reminders, 15% had incorrect contact information, and 15% had missed opportunities for vaccination. In the univariate analysis, reminders improved coverage rates, but only for the children sent continuous reminders (51.2% vs. 44.9% controls, p < .01). Multivariate analysis showed reminders had no independent effect on immunization outcomes. Age, up-to-date and Medicaid status at randomization were strong predictors of a child receiving any subsequent immunization. However, reminders interacted synergistically with Medicaid to increase the likelihood of receiving an immunization.
At an inner city practice network, registry reminders were not effective at improving immunization outcomes due to major system barriers. Immunization registries are powerful vehicles for identifying children in need of immunizations and generating reminders but system challenges must be addressed if this promise is to be achieved in inner city practices.
评估两种连续登记提醒方案的有效性以及提醒与儿童特征对免疫接种率的交互作用。
在纽约市的一个市中心医疗网络中，我们将1662名6周龄至15个月龄、白喉-破伤风-百日咳（DTaP）疫苗应种或逾期未种的儿童随机分为3组：持续提醒组（按需提醒）、有限提醒组（最多3次提醒）和对照组，为期6个月。提醒由医院登记系统触发，免疫接种情况通过医院和城市登记系统进行跟踪。分析基于意向性分析。
随机分组时，研究组具有可比性（年龄9.2个月，77%为拉丁裔，86%为医疗补助计划受益儿童，49.3%按时接种）。四分之一的儿童收到了错误提醒，15%的儿童联系信息不正确，15%的儿童错过接种机会。在单变量分析中，提醒提高了接种覆盖率，但仅对持续收到提醒（51.2%对比对照组44.9%，p<0.01）的儿童有效。多变量分析显示提醒对免疫接种结果无独立影响。随机分组时的年龄、按时接种情况和医疗补助计划受益状况是儿童后续接受任何免疫接种的有力预测因素。然而，提醒与医疗补助计划存在协同作用，增加了接受免疫接种的可能性。
在市中心医疗网络中，由于主要的系统障碍，登记提醒在改善免疫接种结果方面无效。免疫接种登记系统是识别需要免疫接种儿童并生成提醒的有力工具，但如果要在市中心医疗机构实现这一目标，必须解决系统方面的挑战。
