Rochester Childhood Immunization Program “We are at the national forefront of evaluating the delivery of new vaccines, prevention of disease, and how to improve ways to bring effective vaccines to kids." –Peter Szilagyi, M.D., Ph.D. The Rochester Childhood Immunization Program is a collaboration of the Monroe County Department of Health and nearly all primary care pediatric and family medicine practices in Monroe County. It was designed to study the effect of a community-wide reminder, recall, and outreach (RRO) system on known disparities in childhood immunization rates and preventive care among certain populations. Across Monroe County, including the city of Rochester, rates among inner city versus suburban children and among white, black, and Hispanic children were tracked. The RRO system was implemented in 8 city practices in 1995 and was expanded to 10 city practices in 1999. Today this program involves 12 practices, covering 70% of children 0 to 3 years of age, plus 5 primary care practices in Yates and Ontario counties. What We Do Community-based outreach workers track immunization rates of all children through 24 months, and provide a staged intervention with varying intensity depending on the degree to which children were behind in their immunizations. All families are contacted through mail, email, or telephone; some received assistance with transportation or scheduling; and home visits are provided for the small number of children who are the most behind and face the most complex barriers to care. Why it is Needed Despite childhood immunization coverage as one of our most important public health achievements, differences in immunization rates continue. Rates nationally continue to be lower among children living in poverty, urban settings, and among children who are black and Hispanic. Interventions have demonstrated effectiveness in specific clinical settings, but there is little evidence that these interventions work across populations. Pioneering work in Rochester tackled the issue at a community-wide level in an attempt to affect a large population. Making a Difference Immunization rates among infants to two-year-old children were measured at three time periods over six years in the city of Rochester, the inner city (which has the greatest poverty level), and in the suburbs. Rates were measured prior to the intervention in 1993, in 1996 when 46% of inner city and other city children received the intervention, and again in 1999 when 68% had received the intervention. The results were impressive, rising steadily throughout the county with the greatest rise in the inner city and the rest of the city. Disparities in immunization rates between the inner city and suburbs were reduced from18-21% difference in rates in 1993 to only a 4-5% difference in rates three years later. By 1999, all statistically significant differences in immunization rates were eliminated. Similar results were achieved among race and ethnicity variables. In 1996, immunization rates for white children were 11 to 15% higher than those for black and Hispanic children. By 1999, the differences were no longer statistically measurable. By 1999, immunization rates throughout Monroe County (even in the city) surpassed state and national rates.