Increasing immunization rates among inner-city, African American children: A randomized trial of case management

David Wood, Neal Halfon, Cathy Donald-Sherbourne, Rebecca M. Mazel, Mark Schuster, Julie Shea Hamlin, Margaret Pereyra, Patricia Camp, Mark Grabowsky, Naihua Duan

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Context. Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner- city areas have been largely untested. Objective. To assess the effectiveness of case management in raising immunization levels among infants of inner- city, African American families. Design. Randomized controlled trial with follow-up through 1 year of life. Setting. Low-income areas of inner-city Los Angeles, Calif. Patients. A representative sample of 419 African American infants and their families. Interventions. In-depth assessment by case managers before infants were 6 weeks of age, with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed. Main Outcome Measures. Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention. Results. A total of 365 newborns were followed up to age 1 year. Overall, the immunization completion for the case management group was 13.2 percentage points higher than the control group (63.8% vs 50.6%; P=.01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43; 95% confidence interval, 1.26-9.35); for them, immunization levels increased by 28 percentage points. Although for the case management group intervention was not cost-effective ($12 022 per additional child immunized), it was better ($4546) for the 25% of the sample identified retrospectively to have inadequate utilization of preventive health visits. Conclusions. A case management intervention in the first year of life was effective but not cost- effective at raising immunization levels in inner-city, African American infants. The intervention was demonstrated to be particularly effective for subpopulations that do not access well-child care; however, currently there are no means to identify these groups prospectively. For case management to be a useful tool to raise immunizations levels among high-risk populations, better methods of tracking and targeting, such as immunization registries, need to be developed.

Original languageEnglish
Pages (from-to)29-34
Number of pages6
JournalJournal of the American Medical Association
Volume279
Issue number1
DOIs
StatePublished - Jan 7 1998
Externally publishedYes

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Case Management
African Americans
Immunization
Costs and Cost Analysis
House Calls
Los Angeles
Child Care
Population
Cost-Benefit Analysis
Registries
Randomized Controlled Trials
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Newborn Infant
Confidence Intervals
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wood, D., Halfon, N., Donald-Sherbourne, C., Mazel, R. M., Schuster, M., Hamlin, J. S., ... Duan, N. (1998). Increasing immunization rates among inner-city, African American children: A randomized trial of case management. Journal of the American Medical Association, 279(1), 29-34. https://doi.org/10.1001/jama.279.1.29

Increasing immunization rates among inner-city, African American children : A randomized trial of case management. / Wood, David; Halfon, Neal; Donald-Sherbourne, Cathy; Mazel, Rebecca M.; Schuster, Mark; Hamlin, Julie Shea; Pereyra, Margaret; Camp, Patricia; Grabowsky, Mark; Duan, Naihua.

In: Journal of the American Medical Association, Vol. 279, No. 1, 07.01.1998, p. 29-34.

Research output: Contribution to journalArticle

Wood, D, Halfon, N, Donald-Sherbourne, C, Mazel, RM, Schuster, M, Hamlin, JS, Pereyra, M, Camp, P, Grabowsky, M & Duan, N 1998, 'Increasing immunization rates among inner-city, African American children: A randomized trial of case management', Journal of the American Medical Association, vol. 279, no. 1, pp. 29-34. https://doi.org/10.1001/jama.279.1.29
Wood, David ; Halfon, Neal ; Donald-Sherbourne, Cathy ; Mazel, Rebecca M. ; Schuster, Mark ; Hamlin, Julie Shea ; Pereyra, Margaret ; Camp, Patricia ; Grabowsky, Mark ; Duan, Naihua. / Increasing immunization rates among inner-city, African American children : A randomized trial of case management. In: Journal of the American Medical Association. 1998 ; Vol. 279, No. 1. pp. 29-34.
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