Reminder/Recall System to Address Decreased Pediatric Immunization Rates: A Quality Improvement Project

BACKGROUND:

Routine immunization rates have decreased in Tennessee over the last several years. Immunizations are vital to prevent disease outbreaks and to promote the growth and development of children. One proven intervention to increase immunization rates are reminder/recalls to patients that are due or overdue for immunizations.

LOCAL PROBLEM:

A pediatric clinic in Knoxville, TN that serves socioeconomically disadvantaged children has had an increasing number of patients due/overdue for immunizations. Prior to the DNP project, they did not have any standard efforts to address the issue. The goals of the project were: 1) to improve immunization rates in the targeted population, 2) to implement a sustainable reminder/recall system, 3) to improve clinic staff understanding of the importance of on-time immunizations, 4) to promote future initiatives, and 5) translate intervention to a larger scale.

METHODS:

This project utilized the Model for Improvement to implement a reminder/recall system for 0-3-year-olds that were due or overdue for recommended immunizations. PDSA cycles guided three intervention deployments. Receipt of vaccination was measured in those that received a reminder/recall message.

INTERVENTIONS:

Three reminder/recalls were deployed utilizing the state’s immunization registry, TennIIS, to patients 0-3-years-old that were due or overdue for immunizations. The three methods were mailed letters, phone calls, and emails.

RESULTS:

A total of 34% of the patients sent a reminder/recall returned to the clinic and received a vaccine. The overall percentage of patients in this age range due/overdue for immunizations decreased from 51% of the population at the beginning of the project to 38% after the completion of the project.

CONCLUSIONS:

The use of reminder/recalls increased immunization rates in a vulnerable population at this setting and should be continued in the future. It was most effective in the youngest patients < 9 months based on outcome data. A total of two deployments of reminder/recall was effective in this clinic setting.