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 RAND.org on December 31, 1997

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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