You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 279 No. 1, January 7, 1998 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Original Contribution
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on ISI (56)
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Topic Collections
 •Immunization
 •Alert me on articles by topic

Increasing Immunization Rates Among Inner-City, African American Children

A Randomized Trial of Case Management

David Wood, MD, MPH; Neal Halfon, MD, MPH; Cathy Donald-Sherbourne, PhD; Rebecca M. Mazel, MA; Mark Schuster, MD, PhD; Julie Shea Hamlin, MA; Margaret Pereyra, PhD; Patricia Camp, MS; Mark Grabowsky, MD, MPH; Naihua Duan, PhD

JAMA. 1998;279:29-34.

Context.— Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested.

Objective.— To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families.

Design.— Randomized controlled trial with follow-up through 1 year of life.

Setting.— Low-income areas of inner-city Los Angeles, Calif.

Patients.— A representative sample of 419 African American infants and their families.

Interventions.— In-depth assessment by case managers before infants were 6 weeks of age, with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed.

Main Outcome Measures.— Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention.

Results.— 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 (63.8% vs 50.6%; P=.01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43; 95% confidence interval, 1.26-9.35); for them, immunization levels increased by 28 percentage points. Although for the case management group intervention was not cost-effective ($12022 per additional child immunized), it was better ($4546) for the 25% of the sample identified retrospectively to have inadequate utilization of preventive health visits.

Conclusions.— 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 no 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.


From RAND, Santa Monica, Calif (Drs Wood, Halfon, Schuster, Donald-Sherbourne, Duan and Mss Camp and Mazel); the Department of Pediatrics, Shriners Hospitals, Tampa, Fla (Dr Wood and Ms Hamlin); Department of Community Health, School of Public Health (Drs Halfon and Pereyra), and Department of Pediatrics, School of Medicine (Drs Halfon and Schuster), University of California, Los Angeles; and Vaccine and Prevention Research Branch, Division of AIDS, National Institutes of Health, Bethesda, Md (Dr Grabowsky).



THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Community-Based Strategies to Reduce Childhood Immunization Disparities
Findley et al.
Health Promot Pract 2006;7:191S-200S.
ABSTRACT  

Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.
Dietrich et al.
ANN INTERN MED 2006;144:563-571.
ABSTRACT | FULL TEXT  

Effect of Telephone Reminder/Recall on Adolescent Immunization and Preventive Visits: Results From a Randomized Clinical Trial
Szilagyi et al.
Arch Pediatr Adolesc Med 2006;160:157-163.
ABSTRACT | FULL TEXT  

Racial/Ethnic Disparities in Preschool Immunizations: United States, 1996-2001
Chu et al.
Am. J. Public Health 2004;94:973-977.
ABSTRACT | FULL TEXT  

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population: A Cluster Randomized Controlled Trial
Hambidge et al.
Arch Pediatr Adolesc Med 2004;158:162-169.
ABSTRACT | FULL TEXT  

Effectiveness of Individually Tailored Calendars in Promoting Childhood Immunization in Urban Public Health Centers
Kreuter et al.
Am. J. Public Health 2004;94:122-127.
ABSTRACT | FULL TEXT  

Do HMOs Affect Educational Disparities In Health Care?
Fiscella et al.
Ann Fam Med 2003;1:90-96.
ABSTRACT | FULL TEXT  

The Effect of a Parenting Education Program on the Use of Preventive Pediatric Health Care Services Among Low-Income, Minority Mothers: A Randomized, Controlled Study
El-Mohandes et al.
Pediatrics 2003;111:1324-1332.
ABSTRACT | FULL TEXT  

The Effectiveness of Assessment and Referral on Immunization Coverage in the Special Supplemental Nutrition Program for Women, Infants, and Children
Ashkar et al.
Arch Pediatr Adolesc Med 2003;157:456-462.
ABSTRACT | FULL TEXT  

Reducing Geographic, Racial, and Ethnic Disparities in Childhood Immunization Rates by Using Reminder/Recall Interventions in Urban Primary Care Practices
Szilagyi et al.
Pediatrics 2002;110:e58-58.
ABSTRACT | FULL TEXT  

Visiting Multiple Sites for Immunization and Vaccine Coverage Levels of Preschool Children in 3 Urban Clinics: Potential Indicator of Record Scatter?
Joseph et al.
CLIN PEDIATR 2002;41:249-256.
ABSTRACT  

Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care
Schneider et al.
JAMA 2002;287:1288-1294.
ABSTRACT | FULL TEXT  

Racial Disparity in Influenza Vaccination: Does Managed Care Narrow the Gap Between African Americans and Whites?
Schneider et al.
JAMA 2001;286:1455-1460.
ABSTRACT | FULL TEXT  

Registry-Driven, Community-Based Immunization Outreach: A Randomized Controlled Trial
Wilcox et al.
Am. J. Public Health 2001;91:1507-1511.
ABSTRACT | FULL TEXT  

Effectiveness of a Practice-Based Intervention to Increase Vaccination Rates and Reduce Missed Opportunities
Minkovitz et al.
Arch Pediatr Adolesc Med 2001;155:382-386.
ABSTRACT | FULL TEXT  

Effect of Patient Reminder/Recall Interventions on Immunization Rates: A Review
Szilagyi et al.
JAMA 2000;284:1820-1827.
ABSTRACT | FULL TEXT  

Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care
Fiscella et al.
JAMA 2000;283:2579-2584.
ABSTRACT | FULL TEXT  

Characteristics of Families Who Attend Free Vaccine Fairs
Hambidge et al.
Pediatrics 1999;104:158-163.
ABSTRACT | FULL TEXT  

Impact of Community Volunteers on Immunization Rates of Children Younger Than 2 Years
Barnes et al.
Arch Pediatr Adolesc Med 1999;153:518-524.
ABSTRACT | FULL TEXT  

Immunization Performance Measurement in a Changing Immunization Environment
Rodewald et al.
Pediatrics 1999;103:889-897.
ABSTRACT | FULL TEXT  

Reconfiguring Child Health Services in the Inner City
Wood and Halfon
JAMA 1998;280:1182-1183.
FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 1998;1:100-104.
FULL TEXT  

Utilization of Well-child Care Services for African-American Infants in a Low-income Community: Results of a Randomized, Controlled Case Management/Home Visitation Intervention
Schuster et al.
Pediatrics 1998;101:999-1005.
ABSTRACT | FULL TEXT  

Reducing Missed Opportunities to Vaccinate During Child Health Visits: How Effective Are Parent Education and Case Management?
Wood et al.
Arch Pediatr Adolesc Med 1998;152:238-243.
ABSTRACT | FULL TEXT  

INCREASING IMMUNIZATION RATES IN INNER-CITY CHILDREN
JWatch General 1998;1998:8-8.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1998 American Medical Association. All Rights Reserved.