Centralized IIS-based Reminder/Recall to Increase Childhood Influenza Vaccination Rates in New York State
Condition: Reminder System for Influenza Vaccines
MeSH terms: Influenza, Human
Study type: Interventional

Summary: 
      Despite U.S. guidelines for influenza vaccination of all children starting at age 6 months,
      only about half of children are vaccinated annually, leading to substantial influenza disease
      in children and spread of disease to adults. A major barrier is that families are not
      reminded about the need for their children to receive influenza vaccination. The
      investigators will evaluate the impact of patient reminder/recall performed by state
      immunization information systems to improve influenza vaccination rates by using three
      clinical trials in two states. The investigators will assess effectiveness and
      cost-effectiveness of phone reminder/recall on improving influenza vaccination rates. The
      investigators will disseminate the state immunization information system-based
      reminder/recall system to all states for use for seasonal and pandemic influenza vaccinations
      with the goal of lowering influenza morbidity.
    

Detailed description: 
      Annual epidemics of influenza A and B cause substantial morbidity and mortality in the US
      with high rates of hospitalizations, emergency department visits, outpatient visits, and
      medical costs. Children experience significant morbidity from influenza and also play a key
      role in instigating and expanding epidemics. In addition, concerns about pandemic influenza
      heighten the importance of new mechanisms to rapidly inform the population about influenza
      and direct efforts for rapid vaccine delivery.

      Since 2010, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza
      vaccination for all children >6 months of age. However, vaccination rates remain very low.
      For the 2012-2013 season, only 56% of children 2-17y were vaccinated. Modeling studies
      suggest that as many as 19 million cases of influenza could be prevented if child vaccination
      rates were raised to 70% nationally. The most effective strategy recommended by CDC and the
      Task Force on Community Preventive Services for improving childhood influenza vaccination
      rates is reminder/recall (R/R), sent by phone or mail, notifying parents of the need to
      vaccinate their child. The published literature suggests R/R can improve influenza
      vaccination rates. However, few practices use R/R; barriers are practice costs, insufficient
      staff time and expertise, and lack of predictability regarding receipt of vaccine supplies.

      Statewide immunization information systems (IISs) now exist in all states to track
      vaccinations. They have not yet been used for influenza vaccine R/R because of lack of
      evidence for their effectiveness and a lack of a template for IIS-based reminder/recall. The
      investigators have united two leading immunization research groups (Denver, CO and Rochester,
      NY) to assess the impact of centralized IIS-based influenza vaccine reminder/recall, and to
      evaluate the effect of intensity of recall (1 v. 2. v. 3 reminders) over usual care. The
      investigators will also develop tools to aid other states in creating efficient IIS
      reminder/recall systems. The investigators will also develop tools to aid other states in
      creating efficient IIS reminder/recall systems for seasonal and possible pandemic influenza
      outbreaks.

      The study has four aims:

      Aim 1 is to develop the protocols, clinical decision support, and message content for state
      IISs to conduct reminder/recall for influenza vaccinations.

      Aim 2 is to conduct a pragmatic trial, with randomization at the level of the patient within
      practices randomly selected to be proportionate to each state, to compare: 1) effectiveness
      and cost-effectiveness of centralized reminder/recall of different intensity (1 v.2 v. 3
      messages) and usual care (0 messages) and 2) effectiveness and cost-effectiveness of
      reminder/recall in specified subgroups (family medicine vs. pediatric provider, rural vs
      urban, age of child) on receipt of influenza vaccination.

      Aim 3 will measure the effect of adding mailed or text message reminder/recall for autodialer
      failures vs. autodialer-alone reminder/recall on influenza vaccination rates using a 2-arm
      randomized controlled trial.

      Aim 4 (dissemination aim) will develop a toolkit for state IIS-based influenza vaccine
      reminder/recall for seasonal and pandemic influenza, and work with key stakeholders on a
      sustainability plan.

      By the end of the study, the investigators will have a feasible and cost-effective model to
      raise child seasonal or possibly pandemic influenza vaccination rates to prevent influenza.
      The investigators will disseminate the IIS model to all states.
    

Intervention name(s): 1 Notice; 2 Notices; 3 Notices
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): 1 Reminder notification via autodialer; 2 Reminder notifications via autodialer; 3 Reminder notifications via autodialer
Other intervention name(s): reminders, notifications
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: reminder systems; Influenza vaccines