1. Evaluation of the San Diego County Baby Track Program
Sapna Dharkar-Surber1, K. Michael Peddecord2, Kathleen W. Gustafson3, Suzi Bouveron4, and Jackie K. Workman3.
(1) San Diego Immunization Partnership, UC San Diego (2) Graduate School of Public Health, San Diego State University (3) San Diego County Immunization Program, County of San Diego Health and Human Services Agency (4) Information and Education Section, State of California, Department of Health Services, Immunization Branch

2. Objectives Characterize the Baby Track Program in San Diego County.
Identify the most effective method of reminders for Baby Track participants.
Identify future directions for the Baby Track program.

3. What is Baby Track?
The Baby Track Program is a hospital-based volunteer program.
Designed to educate new parents about immunization.
Explains the importance of adhering to the immunization schedule.
Serves to remind new parents of their newborn’s immunization schedule.
The Baby Track Program is a hospital-based volunteer program designed to perform some important functions. The program is designed to educate new parents about immunization and the importance of adhering to the immunization schedules. The Baby Track Program serves to remind new parents of their newborns immunization schedule.

4. How does Baby Track Work?
Volunteers enroll parents
Bedside visits
Work with nursing staff
Participation is voluntary
Participants elect to receive a combination of the following:
Postcards
Reminder phone calls
Types of reminders performed by volunteers:
Postcard only
Speak in person
Leave a message on the machine
Any combination of the above
Calls/postcards/reminders performed at 3, 5 and 7 months post partum.

5. Background Problem: Extreme low rates of immunizations for children.
Solution:
Standard immunization records.
School immunization law.
Provider-based program.
Hospital-based program.
In 1977, a survey completed by the California Department of Health Services Immunization program demonstrated the low rates of immunization of the children of teenage mothers. In response, a four-component system was implemented. The first objective was to standardize the immunization records kept by parents and schools. Second, a school immunization law was passed in 1978 mandating that all immunization series and boosters must be complete in order for the child to be enrolled in school. Third, a provider-based program was developed for private physicians and clinics to follow up with children. Finally, a hospital based program of new mothers that would serve simultaneously as an educational and reminder program.

6. Current Situation
16 Birthing Hospitals in SD County (Reported births, 2004: 47,639)
12 Participating Baby Track Hospitals
(Reported births, 2004: 35,343)
11% of births are enrolled in Baby Track in 2004 (3,979 participants)
Currently, there are over 47,000 births in San Diego County. Of the 16 birthing hospitals, currently only 12 participate in the Baby Track program. Within these hospitals, the program is implemented at an 11% enrollment rate.
Enrollment is based on the number of volunteers within the given hospital. At one time, all hospitals in San Diego County participated in Baby Track.

7. Tracking Immunizations
Prior to August 2004, immunization information was extracted from the enrollment forms, and entered into a database.
Immunization rates (up to date or not) and volunteer activity were monitored.
Summary Sheet Tracking: Done for individual hospitals and for all hospitals. This is completed in aggregate for each hospital, and no individual data for participants is collected. Immunization rates: At 3, 5, 7 months: self reported if they are up to date or not. Volunteer activity: postcards sent, messages left and/or if they spoke to a person at the house.

8. The Pilot Study Purpose Three Selected Hospitals
Assess the reminder method at each of the selected hospitals.
Evaluate immunization adherence of program participants compared to non-participants.
Three Selected Hospitals
Hospital 1 (North Region)
Hospital 2 (East Region)
Hospital 3 (Central Region)
The primary purpose of this study was to assess the reminder method at each of the selected participating Baby Track hospitals in San Diego County. A secondary outcome that will also be assessed is to determine whether providing parents educational materials and regular reminders increased immunization schedule adherence. To test this hypothesis we evaluated the effectiveness of three different Baby Track Programs in San Diego County. Using the San Diego Web-Based Registry, we measured the immunization rates associated with each program and used these results as a marker of schedule compliance and program effectiveness. A comparative cohort was obtained from the San Diego Birth Registry of children who were not enrolled in the Baby Track program Hospitals were selected to geographically represent SD County. It is a pilot study and feasibility was taken into account, which is why not all hospitals were used in this pilot study.

9. Methods-The Pilot Study
Enrollment forms received between August 2004-January 2005 were recorded into a database.
Patient information was extracted.
Maternal Race
Participation in Baby Track
Type of reminder
Overall immunization status
Control cases for comparison were obtained from the San Diego County Birth Registry.
Matched by month of birth
Information obtained through the San Diego Immunization Registry, the San Diego County Birth Registry and the Baby Track enrollment forms.

10. Baby Track Sample
Number of Births, Feb-Jun 2004
Participants in Baby Track
Participants located in the Registry
Immunization Records H1
592
340 38 26 H2
1969
168 44 22 H3
1878
850
521 5
This gives an overview of how the sample size was obtained. Discrepancy in the Registry vs Immunization records can be explained by the fact that only clinics and providers that activate a child’s immunization record can be observed in the registry.
Therefore, records may be in the SDIR but immunization records must be activated at clinic site.
Hospital 1 (H1);North Region: Hospital 2 (H2);East Region: Hospital 3 (H3);Central Region

11. Maternal Ethnicity by Region

12. Immunization Status by Maternal Ethnicity
UTD: Up to Date: 2 IPV; 3 DTaP; 2 Hib; 2 Hep B; 2 PCV7

13. Immunization Status by Reminder Method
UTD: Up to Date: 2 IPV; 3 DTaP; 2 Hib; 2 Hep B; 2 PCV7
* At least one personal contact by a Baby Track volunteer

14. Immunization Status by Region
UTD: Up to Date: 2 IPV; 3 DTaP; 2 Hib; 2 Hep B; 2 PCV7

15. Reminder Method by Region
UTD: Up to Date: 2 IPV; 3 DTaP; 2 Hib; 2 Hep B; 2 PCV7
* At least one personal contact by a Baby Track volunteer

16. Immunization Compliance
UTD: Up to Date: 2 IPV; 3 DTaP; 2 Hib; 2 Hep B; 2 PCV7

17. Conclusions Volunteers are the key to a successful Baby Track Program.
The type of reminder utilized greatly affects the immunization status of the child.
Baby Track can easily be implemented at other hospitals.
This pilot study needs to be evaluated on a larger scale to obtain more power for the statistical results achieved by this pilot. Within the program, the type of health ed really makes a difference and more training should be given to the volunteers to emphasize their important role in the iz status of children. Due to the versatility with working with volunteers, each hospital can cater this program to its existing framework.

18. Suggestions
Capitalize on the wealth of resources offered by strong volunteer bases at hospitals.
Provide further training to volunteers regarding the importance of direct contact.
Evaluate the structure of volunteers at each hospital and provide training to implement the Baby Track program.
Suggestions for future implementation at other hospitals in other counties and states-

19. Acknowledgements San Diego Immunization Partnership, UC San Diego
San Diego County Immunization Branch, County of San Diego Health and Human Services
State of California, Department of Health Services, Immunization Branch
San Diego Immunization Regional Registry
Graduate School of Public Health, San Diego State University
I’d like to thank the CDC for the opportunity to present my findings and all the people on this slide

20. San Diego Immunization Program
Contact Information
Sapna Dharkar-Surber
San Diego Immunization Program