Impact of Appointment Reminders on Vaccination Coverage at an Urban Clinic

OBJECTIVE: To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates. Design. Controlled trial. SETTING: Pediatric clinic serving a low-income community in New York City. INTERVENTION: Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346) ; postcard (n = 314) ; telephone call (n = 307) ; and postcard and telephone call (n = 306). OUTCOME MEASURES: Kept-appointment and vaccination coverage rates. RESULTS: Children assigned to the postcard and telephone group were 1. 75 times more likely to keep their appointments than controls (95% confidence interval CI = 1. 2, 2. 5). Children who actually received the postcard and telephone reminders were 2. 3 times more likely to keep an appointment than controls (95% CI = 1. 4, 3. 7). Children who kept appointments were 2. 3 times more likely to be up-to-date with their immunizations (95% CI = 1. 7, 3. 2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment (chi (2) = 11. 2). The cost of the reminders was. 67 for the postcard and 1. 58 for the postcard and telephone. Assuming 5000 visits per year and 100 reimbursement per visit, the return on each dollar invested was 10 for the postcard and 7. 28 for the postcard and telephone reminder. CONCLUSIONS: Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date. appointment reminder, vaccination coverage.