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【正文】 ven, munityased immunization outreach: a randomized controlled trial. AJPH 2022。91:150711. oute research 44 Outreach: background/goal/hypothesis ? Background: – providerbased vs. munitybased registrydriven outreach ? Goal/hypothesis: – whether munitybased registrydriven outreach can improve immunization rate – whether predictors of under immunization can be used to target atrisk children oute research 45 Outreach: study design ? Randomized controlled trial –three groups ?outreach (two samples) ?mailed reminder letter ?control: no intervention –no doubleblindness ?both subjects and raters were not blind. –randomized by individual oute research 46 Outreach: subjects – KIDS immunization database/tracking system – Philadelphia, 1997 – 1696 610 months children/2 random samples – a second random sample: 160 all assigned to the outreach group – no informed consents – IRB review (Albert Einstein Medical Center) oute research 47 Outreach: subjects –1856 children (1696+160) ?104 did not meet participation criteria… 1752 ?23% immunization history inplete ?4% refused to give history ?16% fail to contact –991 with immunization history 57% ?outreach 379: control 612 ?further exclusion: those updated by 7 months –3 DTO, 2 OPV, 2 Hib, 2 HBV oute research 48 Outreach: exposure/intervention –two munitybased anizations contracted by the DPH –2/3 bilingual social services agency ?outreach 1/3 ?reminder letter 1/3 ?no intervention 1/3 –1/3 university nursing center ?outreach 1/2 ?reminder letter 1/4 ?no intervention 1/4 oute research 49 Outreach: exposure/intervention ? Outreach –outreach workers –locate the family, obtain the immunization history, assess whether up to date –update the registry, 4 attempts –differences between two agencies oute research 50 Outreach: endpoints ? Primary –Receive immunization during observation period –For notupdate children only –missing more than the third DTP (degree of delay) ? Secondary oute research 51 Outreach: data analysis ? Exclusion and reasons (Table 1) ? Basic characteristics –for confounding and possible selection bias (Table 1) oute research 52 Outreach: data analysis ? Efficacy –Only for notontime –Adjusting for confounders and assess the effects of predictors (Table 2) –Improve immunization rate (Table 3) ?parable? oute research 53 Outreach: major results/discussion –Comparability: not parable?! –Efficacy ?must adjust confounders ?only for notupdated … why not exclude first? ?information bias: no blindness –Conclusion ?Identify high risk children and bring them to care
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