A stepped intervention increases well-child care and immunization rates in a disadvantaged population.

Objective: To test a stepped intervention of reminder/recall/case management to increase infant well-child visits and immunization rates.

Methods: We conducted a randomized, controlled, practical, clinical trial with 811 infants born in an urban safety-net hospital and followed through 15 months of life. Step 1 (all infants) involved language-appropriate reminder postcards for every well-child visit. Step 2 (infants who missed an appointment or immunization) involved telephone reminders plus postcard and telephone recall. Step 3 (infants still behind on preventive care after steps 1 and 2) involved intensive case management and home visitation.