Randomized controlled trial of the effect of case management on immunization receipt in the first year of life

D. L. Wood, N. Halfen, C. D. Sherboume, J. Hamlin, M. Pereyra

Research output: Contribution to journalArticle

Abstract

Background. Despite recent gains in Immunization levels nationally, rates in urban, poor populations remain low. We hypothesized that more timely utilization of well child care visits and immunizations could be promoted through case management services that included home visits and telephone contacts. Design. Approximately 400 African American women/newborn pairs born in an inner city area were randomized into control or case management (CM) groups. At one year maternal interviews and chart abstractions from provider records were conducted. Intervention. The CM group was assigned a case manager who made an average of 4 home visits during the year. Enrolled families were given education on immunizations, Medicaid and sources of well child care. They were contacted after each Immunization was due and assisted with access to providers if they missed immunization milestones. Both groups were given a health passport designed and distributed by the State of California. Outcome Measures. Children were considered up-to-date if by 12 months of age they had received 3 DTP and 2 OPV. Number of well child visits are also assessed as an outcome. Results. Preliminary data from the baseline and exit interviews are presented. There were no important demographic differences between the case management and control groups. 74% of the CM and 58% of the Control groups were UTD at 12 months (p < .01). Late receipt of immunization was also associated with higher sibling position (p < .01 ), having ever missed an appointment for immunizations (p < .001), maternal smoking (p < .01 ), and number of life difficulties experienced (p < .01). Logistic regression analysis confirmed the findings from the bivariate analyses. Cost benefit analyses are discussed. Conclusions. Among an impoverished, high risk population case management raised the rate of early receipt of immunizations in the first year of life by 16 percentage points. Other factors related to family structure and maternal smoking were also important predictors of immunization status.

Original languageEnglish
JournalJournal of Investigative Medicine
Volume44
Issue number1
StatePublished - Dec 1 1996

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Immunization
Case Management
Randomized Controlled Trials
Mothers
Smoking
House Calls
Child Care
Interviews
Control Groups
Urban Population
Medicaid
Telephone
Regression analysis
African Americans
Cost-Benefit Analysis
Logistics
Siblings
Appointments and Schedules
Managers
Education

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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Randomized controlled trial of the effect of case management on immunization receipt in the first year of life. / Wood, D. L.; Halfen, N.; Sherboume, C. D.; Hamlin, J.; Pereyra, M.

In: Journal of Investigative Medicine, Vol. 44, No. 1, 01.12.1996.

Research output: Contribution to journalArticle

Wood, D. L. ; Halfen, N. ; Sherboume, C. D. ; Hamlin, J. ; Pereyra, M. / Randomized controlled trial of the effect of case management on immunization receipt in the first year of life. In: Journal of Investigative Medicine. 1996 ; Vol. 44, No. 1.
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abstract = "Background. Despite recent gains in Immunization levels nationally, rates in urban, poor populations remain low. We hypothesized that more timely utilization of well child care visits and immunizations could be promoted through case management services that included home visits and telephone contacts. Design. Approximately 400 African American women/newborn pairs born in an inner city area were randomized into control or case management (CM) groups. At one year maternal interviews and chart abstractions from provider records were conducted. Intervention. The CM group was assigned a case manager who made an average of 4 home visits during the year. Enrolled families were given education on immunizations, Medicaid and sources of well child care. They were contacted after each Immunization was due and assisted with access to providers if they missed immunization milestones. Both groups were given a health passport designed and distributed by the State of California. Outcome Measures. Children were considered up-to-date if by 12 months of age they had received 3 DTP and 2 OPV. Number of well child visits are also assessed as an outcome. Results. Preliminary data from the baseline and exit interviews are presented. There were no important demographic differences between the case management and control groups. 74{\%} of the CM and 58{\%} of the Control groups were UTD at 12 months (p < .01). Late receipt of immunization was also associated with higher sibling position (p < .01 ), having ever missed an appointment for immunizations (p < .001), maternal smoking (p < .01 ), and number of life difficulties experienced (p < .01). Logistic regression analysis confirmed the findings from the bivariate analyses. Cost benefit analyses are discussed. Conclusions. Among an impoverished, high risk population case management raised the rate of early receipt of immunizations in the first year of life by 16 percentage points. Other factors related to family structure and maternal smoking were also important predictors of immunization status.",
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