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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.

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