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Increasing Appropriate Vaccination: Home Visits to Increase Vaccination Rates

Home visits intended to increase vaccination rates:

  • Provide vaccinations to clients in their homes, or
  • Promote recommended vaccinations with referral to available immunization services

Home visits may be conducted by either vaccination providers, such as nurses, or by other providers, such as social workers. Visits generally include an assessment of client vaccination status and a brief discussion of the importance of the indicated immunizations.

The intervention may be directed to:

  • All clients in a designated population, such as low-income single mothers, or
  • Only those clients who have been unresponsive to previous intervention efforts, such as client reminder and recall systems

Home visits may be the primary or sole intervention or one component of a larger healthcare system or community-based program to increase vaccination rates.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates.

However, the Task Force also notes that home visits can be resource-intensive and costly relative to other options for increasing vaccination rates. Evidence on effectiveness was considered strong based on a body of evidence that included studies of home visits delivered to all clients or only to those unresponsive to other interventions, home visits focused on vaccination alone or in combination with other health concerns, and home visits that provided vaccinations on-site or referred clients to vaccination services outside the home.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

 

Results from the Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2000 (search period 1980-1997) combined with more recent evidence (search period 1997-2009). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination. This finding updates and replaces the previous Task Force finding on Home Visits to Increase Vaccination Rates (read the evidence review and Task Force finding in our library).

Nineteen studies qualified for the review (seven from the previous review and twelve from the more recent search).

  • Median increase in vaccination rates overall: 10 percentage points (interquartile interval [IQI]: 3 to 17 percentage points; 17 studies, 18 study arms).
  • Improvements were observed in home visits delivered universally (12 study arms) and to clients who were unresponsive to previous intervention efforts (6 study arms).
  • Home visits led to a change in vaccination rates whether they were delivered as the sole intervention or as part of a larger healthcare system or community-based program.

Economic Evidence

This economic review includes four studies from the previous review and 5 from the updated review. Monetary values are reported in 2009 U.S. dollars.

  • Home visits tend to be resource intensive partly because multiple contacts and visits to the home may be necessary for a successful vaccination.
  • Two studies from the previous review reported cost per additional up-to-date vaccination ranged from $513 to over $13,000.
    • Greater expenses were attributed to high start-up costs and intense evaluations of each client's well-child and immunization status.
  • Four studies from the updated review provided estimates of cost per person with a median of $51.96 (IQI: $37.98 to $72.88), and cost per up-to-date vaccination with a median of $1022.78 (IQI: $472.34 to $1420.68).
  • One study from the updated review modeled the cost-effectiveness of hepatitis B vaccination in a high-risk population, and estimated incremental cost per QALY of $6808 to $81,838 under best and worst case assumptions.

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.

 




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing appropriate vaccination: home visits to increase vaccination rates. www.thecommunityguide.org/vaccines/universally/homevisits.html. Last updated: MM/DD/YYYY.

Review completed: March 2009