19. You have found that there is room for improvement in pediatric vaccination rates. One of the nurses suggests sending letters to remind both adult patients and the parents of pediatric patients when vaccinations are needed. However, your office manager reminds you that the budget is tight this year. Sending letters would be an extra expense. Based on evidence and current recommendations, what should you do?

• Either send the letters or institute a system of reminder phone calls.
• Send letters only for pediatric patients, because reminders work for children but not adults.
• Do not use letters or phone calls, because reminder systems for patients do not work.
• Institute a system of reminder phone calls instead of letters, because calls have been proven to have greater effect.