Public Release: 

Study tested centralized system for reminding families about immunizations

The JAMA Network Journals

A centralized notification system to remind families about childhood immunizations run in collaboration with public health departments and physician practices was modestly more effective than a practice-based notification system, which few practices implemented, according to an article published online by JAMA Pediatrics.

Reminder/recall notification systems for immunizations have been shown to be a way to help increase immunization rates. However, the use of such systems by primary care practices has been less than 20 percent nationally because of numerous barriers to implement a system that relies on phone calls and mailings, according to the study background.

Allison Kempe, M.D., M.P.H., of Children's Hospital Colorado, Aurora, and coauthors conducted a randomized trial using the Colorado Immunization Information System (CIIS) to measure the effectiveness of a collaborative centralized (CC) system compared with a practice-based (PB) reminder/recall system. Public health entities, most pediatric practices and many family medicine practices were enrolled in CIIS, which collects vaccination data.

The study included 18,235 children (ages 19 to 35 months) in 15 Colorado counties. Patients in the CC group received autodial and mail reminders or mail reminders only. Practices in the PB group were invited to attend training on a notification system and they were offered reimbursement to help with mailing or generating phone calls.

Study results indicate that 7,873 of 9,049 (87 percent) children in the CC group received at least one contact, while in the PB group the reach was just 75 of 9,189 (0.8 percent) children because only two practices conducted reminder/recall notifications.

Documentation rates for at least one immunization were 26.9 percent for the CC group vs. 21.7 percent for the PB counties and 12.8 percent vs. 9.3 percent of patients, respectively, achieved up-to-date (UTD) status. The CC reminder/recall system was also more cost-effective.

"Our findings and those of previous studies support consideration of a CC compared with a PB reminder/recall approach to increase immunization rates during the preschool years. Sustainable funding mechanisms will be needed to support such an approach and may involve a shared investment between practice organizations or accountable care organizations and the public sector. With minimal contributions from each, substantial cost savings should be realized from a societal perspective," the study concludes.

(JAMA Pediatr. Published online February 23, 2015. doi:10.1001/jamapediatrics.2014.3670. Available pre-embargo to the media at

Editor's Note: The project was supported by a grant from the Agency for Healthcare Research and Quality. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Editorial: Collaboration to Promote the Effective Use of Technology

In a related editorial, Alexander G. Fiks, M.D., M.S.C.E., of the Children's Hospital of Philadelphia, writes: "As the study demonstrates, in certain settings, especially one where the interests of the practice and public health care systems coincide, collaboration with outside groups may prove most effective. Even so, the results of the study remind us that as these collaborations develop, they benefit from building on existing relationships between families and clinicians."

(JAMA Pediatr. Published online February 23, 2015. doi:10.1001/jamapediatrics.2014.3709. Available pre-embargo to the media at

Editor's Note: The author made conflict of interest and funding disclosures. Please see article for additional information, including other authors, author contributions and affiliations, etc.


Media Advisory: To contact author Allison Kempe, M.D., M.P.H., call Mark Couch at 303-724-5377 or email To contact editorial author Alexander G. Fiks, M.D., M.S.C.E., call Dana Weidig at 267-426-6092 or email An author podcast will be available when the embargo lifts on the JAMA Pediatrics website:

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