Increasing Immunization Rates Among Inner-City, African American Children

A Randomized Trial of Case Management

Published In: JAMA, The Journal of the American Medical Association, v. 279, no. 1, Jan. 7, 1998, p. 29-34

Posted on on January 01, 1998

by David L. Wood, Neal Halfon, Cathy D. Sherbourne, Rebecca Mazel, Mark A. Schuster, Julie Hamlin, Margaret Pereyra, Patricia Camp, Mark Grabowsky, Naihua Duan

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The objective of this study was to assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families. Patients included a representative sample of 419 African American infants and their families from low-income areas of inner-city Los Angeles, Calif. 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. In a logistic model, the case management effect was limited to the 25 per cent of the sample who reported 3 or fewer well-child visits; 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 per cent of the sample identified retrospectively to have inadequate utilization of preventive health visits. 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 not 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.

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