The Children’s Primary Care Outreach Program

The Children’s Primary Care Outreach Project is a city-wide reminder, recall and outreach program focused on improving immunization rates and preventive care visits among preschool children and adolescents in the city of Rochester.

The program has demonstrated a 10-20% gain in child and adolescent immunization rates and preventive care visit rates. The project has increased and sustained gains in childhood immunization rates for 18 years using an evidence-based tiered intervention and has recently demonstrated substantial gains in adolescent immunization rates and preventive care visits.

Outreach workers work in 9 large urban practices that together serve over two-thirds of all children and adolescents in the city of Rochester. We serve >5,000 infants/toddlers and >2,000 teens.

The Problem

• Low-income, urban children and adolescents across the country (and previously in Rochester) have suboptimal immunization rates and preventive care visit rates

• Disparities exist between city and suburban children, and between minority and white children (across the country) in these measures

• Many of the factors causing these problems are rooted in poverty

• Lack of preventive care visits results in missed opportunities for screening, anticipatory guidance, and coordination of care

Prior Research

We have performed two large randomized clinical trials to evaluate the impact of a tiered (stepwise) intervention involving reminders + recall + outreach

• 1999: an RCT involving n~2,000 preschool children

• 2011: an RCT involving n~7,000 adolescents)
   

Results

• 10-20% rise in immunization rates

• 10-20% rise in preventive visits

• High satisfaction among parents and medical providers
   

Impact

• Improved immunization rates city-wide

• Reduced disparities in immunizations between:

• City-suburb

• White-minority

Awards

• 2004: Howard J Berman Prize for the greatest improvement in the community’s health

• 2004: CDC rated the program the #1 practice-based immunization delivery program in the US

• 2010: David Satcher Community Health Improvement Award

Funding Sources

• Current: The Monroe Plan for Medical Care, MVP, Strong Health, Rochester General Hospital, Unity Health, MCHB

• Prior: CDC, Monroe County DOH, Daisy Marquis Jones Foundation

References

• Rodewald LE, Szilagyi PG, Humiston SG, Barth R, Kraus R, Raubertas RF. A randomized study of tracking with outreach and provider prompting to improve immunization coverage and primary care. Pediatrics. 103(1):31-8, 1999.

• Szilagyi PG, Bordley C, Vann JC, Chelminski A, Kraus RM, Margolis PA, Rodewald LE. The effect of patient reminder/recall interventions on immunization rates: A review. JAMA 284:1820-1827, 2000

• Szilagyi PG, Schaffer S, Shone L, Barth R, Humiston SG, Sandler M, Rodewald LE. Reducing geographic, racial, and ethnic disparities in childhood immunization rates by using reminder/recall interventions in urban primary care practices. Pediatrics 110:e58, 2002.

• Szilagyi PG, Rickert D, McLaurin J, Tan L, Britto M, Francis A, Dunne E, Rand CM. Delivering Adolescent Vaccinations in the Medical Home: A New Era? Pediatrics. 121(Supplement): S15-S24, 2008.

• Szilagyi PG, Humiston SG, Gallivan S, Albertin C, Sandler M, Blumkin A. Effectiveness of a Citywide Patient Immunization Navigator Program on Improving Adolescent Immunizations and Preventive Care Visit Rates. Arch Pediatr Adolesc Med. 2011;165(6):547-553.