PubMed · 10247247
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M S Dayal. Integrated child development services.. https://pubmed.ncbi.nlm.nih.gov/10247247/
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Both the acute intensive care of premature infants and the management of their long-term medical and educational sequelae are costly. Because neonatal intensive care is very effective in reducing mortality, however, its cost effectiveness as described previously is actually quite favorable when compared with other well-accepted medical interventions, such as coronary artery bypass grafting and renal dialysis. This article has highlighted the relatively scant literature on which those estimates of costs and cost effectiveness of both neonatal intensive care and its component interventions rest. This is particularly true with respect to long-term resource use by graduates of NICUs. Without such information, we cannot hope to allocate resources in a way that ensures optimal care of this vulnerable population.
INTRODUCTION: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life. DESIGN: Randomized, controlled trial. SETTING: County health department in the Denver metropolitan area. STUDY PARTICIPANTS: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines. INTERVENTION: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s). MAIN OUTCOME MEASURE: Immunization series completion at 24 months of age. RESULTS: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = .21; CI [confidence interval] = 1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was $226 ($79 after start-up costs were discounted). CONCLUSION: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.
OBJECTIVE: Concerns about financial barriers to vaccination led to the creation of the Vaccines for Children (VFC) program, which provides free vaccines to states for disadvantaged children. Our objective was to understand the effect of free vaccine and insurance on pediatric nurse practitioners' (PNPs) likelihood of referring children to public vaccine clinics. Although referral from the medical home to public vaccine clinics is preferable to not vaccinating, there are disadvantages, including the potential for windows of inadequate protection and fragmentation of care. METHODS: A standardized survey was conducted by trained personnel using computer-assisted telephone interviewing. We interviewed a national random sample of primary care PNPs in 1997. RESULTS: In 1997, 252 of 271 (93%) directly contacted PNPs were interviewed. The percentage of respondents receiving free vaccines was 82%. Among PNPs not receiving free vaccines, the percentages stating that they were likely to refer insured, Medicaid insured, and uninsured children to public vaccine clinics were 7%, 27%, and 67%, respectively. In contrast, among PNPs receiving free vaccines, only 46% would refer an uninsured child and 10% a Medicaid child. CONCLUSIONS: Most respondents received free vaccine supplies in 1997. Based on current PNP data and previous physician data, most clinicians who do not receive free vaccine supplies are likely to refer uninsured children to public vaccine clinics. In contrast, clinicians who receive free vaccine supplies are much more likely to vaccinate uninsured and Medicaid-insured children.