This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Immunization  • Quality of Care, Other  • Alert me on articles by topic

The Mediating Role of Age-Appropriate Well-Child Care Utilization

Ashley H. Schempf, BS; Cynthia S. Minkovitz, MD, MPP; Donna M. Strobino, PhD; Bernard Guyer, MD, MPH

Arch Pediatr Adolesc Med. 2007;161(1):50-56.

Objective  To prospectively evaluate the impact of parental satisfaction on childhood immunization and the mediating role of age-appropriate well-child care.

Design  Secondary analyses of cohort data from the National Evaluation of Healthy Steps for Young Children. Data sources included an enrollment questionnaire, parent interview at 2 to 4 months, and medical records.

Setting  Twenty-four pediatric practices across the United States.

Participants  A total of 4896 (85%) of the initial 5565 enrolled families who were interviewed at 2 to 4 months and had abstracted medical records.

Main Exposure  Parental satisfaction with overall pediatric care assessed at 2 to 4 months as excellent, good, or fair/poor.

Main Outcome Measures  Age-appropriate first dose of diphtheria-tetanus-pertussis; third dose of diphtheria-tetanus-pertussis; and measles, mumps, and rubella vaccinations; and up-to-date vaccinations at 24 months (4 diphtheria-tetanus-pertussis, 3 polio, and 1 measles, mumps, and rubella).

Results  The majority of parents were satisfied with their child's health care; only 4% rated overall care as fair or poor. Children whose parents reported fair/poor satisfaction with care had a reduced odds of receiving age- appropriate first dose of diphtheria-tetanus-pertussis vaccination (odds ratio, 0.43; 95% confidence interval, 0.28-0.67); third dose of diphtheria-tetanus-pertussis vaccination (odds ratio, 0.52; 95% confidence interval, 0.36-0.74); and measles, mumps, and rubella vaccination (odds ratio, 0.58; 95% confidence interval, 0.37-0.92); and of being up to date by 24 months (odds ratio, 0.65; 95% confidence interval, 0.43-0.99) compared with children whose parents reported excellent care, independent of sociodemographic and maternal health care utilization variables. The negative effect of fair/poor satisfaction on immunization was largely explained by reduced utilization of age-appropriate well-child care.

Conclusion  Quality assurance activities that assess parental satisfaction with care may have added value in identifying children who are less likely to receive timely preventive services.

Author Affiliations: Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Impact of Immunization at Sick Visits on Well-Child Care
Fiks et al.
Pediatrics 2008;121:898-905.
ABSTRACT | FULL TEXT