The impact of outreach efforts in reaching underimmunized children in a Medicaid managed care practice

Background: National immunization standards call for all primary care provi ders to implement immunization tracking systems that include contacting fam ilies when children are overdue for vaccines. The restructuring of Medicaid systems toward managed care models with a greater emphasis on having defin ed medical homes for children presents opportunities to expand the use of i mmunization recall systems among low-income children. Objective: To assess the impact of telephone, mail, and a combined approach to reaching underimmunized children enrolled in a hospital-based Medicaid managed care practice. Design and Methods: All underimmunized children younger than 6 years who ha d been continuously enrolled in the hospital-based Medicaid managed care pr actice for 3 months were randomly assigned to 1 of 4 groups: (1) control gr oup with no intervention, (2) telephone reminder group, (3) mail reminder g roup, or (4) sequential mail/telephone reminder group. After a 10-week foll ow-up, medical records and the hospital's computerized appointment scheduli ng system were reviewed to determine the effect of the outreach effort on a ppointments made, visits attended, immunizations received, and immunization status. Results: Outreach efforts had a positive impact on the proportion of childr en immunized and on the resulting immunization coverage rates. The percenta ge of children receiving immunizations during the 10-week follow-up was 4.2 % (3/71) for the control group, 16.7% (10/ 60) for the telephone reminder g roup, 19.0% (12/63) for the mail reminder group, and 25.7% (18/70) for the sequential mail/telephone reminder group. The percentage of children up-to- date for all immunizations at the end of the 10-week follow-up was 2.8% (2/ 71) for the control group, 13.3% (8/60) for the telephone reminder group, 1 4.3% (9/63) for the mail reminder group, and 17.1% (12/70) for the sequenti al mail/telephone reminder group. Forty-eight children were seen during fol low-up without receiving all indicated vaccines. Conclusions: Outreach efforts were modestly successful in reaching underimm unized children in a Medicaid managed care practice, although the lack of a ccurate information on telephone numbers and addresses limited the effectiv eness. Missed opportunities for immunization also reduced the impact of out reach on immunization coverage.