To improve immunization rates, University of Kansas (KU) developed the Text Reminders for Immunization Compliance in Kids (TRICKs) project that utilized a text reminder system to send out messages to parents before their child was due for an immunization visit. Several feasibility studies at the clinic identified that parents had cellular phones with text messaging capabilities and were open to receiving text messages for immunization reminders. The clinic's electronic medical record had text messaging capabilities which were used to send reminders. After baseline data was collected, clinic records were updated to make sure only current patients were included in immunization rate reports. KU also conducted plan-do-study-act (PDSA) cycles to reduce missed opportunities for immunizations. Clinic-wide training and empowering nurses to remind doctors that an immunization opportunity was about to be missed were implemented based on nurse and physician feedback.

The goal of TRICKs was to reach out to parents using a novel reminder system and increase immunization rates at the KU pediatric clinic.

There was a significant increase in immunization rate following the implementation of parent text reminders when compared to the initial immunization rate.

The project was conducted from December 2011 through October 2012. The initial immunization rate was 9% and the post-intervention immunization rate was 67% following implementation of the new parent reminders. Chi-squared analysis indicated that the clinic's immunization rate improvement was statistically significant (p<0.001). There was a significant decrease in missed opportunities (20% of children's visits had a missed opportunity before the intervention; after the intervention only 10% of the children had a missed opportunity). However, because multiple interventions were implemented the actual effect of the text message reminders cannot be assessed.