Population-based study of the adequacy of well-child care services: a rural county's report card.
OBJECTIVE
To determine the adequacy of well-child care services using a population-based study.


METHODS
The medical records of all county providers and the immunization records at the local health department were reviewed. A county birth cohort, identified using electronic birth certificates, was compared with those who migrated into the area (hereafter, in-migrants).


METHODS
All primary care sites (private, network, etc) in a rural county.


METHODS
Two-year-old children born between May 31, 1993, and May 30, 1994.


METHODS
Immunization rates and preventive screenings.


RESULTS
A total of 674 medical records were reviewed. Of these, 377 (56%) belonged to a county birth cohort and 297 (44%) were in-migrants. Medical records of 64% of the birth cohort were reviewed. Among all 2-year-olds, 80% received 4 doses of diphtheria and tetanus toxoids and pertussis vaccine; 89%, 3 doses of Haemophilus influenzae type b (Hib); 75%, 4 doses of Hib; 77%, 3 doses of hepatitis B vaccine; 85%, measles-mumps-rubella vaccine; 85%, 3 doses of oral poliovirus vaccine; 17%, varicella live virus vaccine (Varivax). The 4:3:1 rate was 75% at age 2 years. Sixty-eight percent had had 1 hematocrit, 74% had 1 lead screening test, and 43% had 2 lead screening tests. A total of 64% had had 6 well-child visits and 30% had had 9. The mean number of weights and heights measured was 4.8 and 4.5, respectively, at age 1 year and 7.3 and 6.8, respectively, at age 2 years. The birth cohort had notably higher rates of documented immunization and preventive screening than in-migrants.


CONCLUSIONS
This study demonstrated immunization coverage at or below the national average, and well-child care service provisions below American Academy of Pediatrics standards at a county level. This study enabled individual primary care sites to assess their well-child care provision and provided a useful baseline for targeting the improvement of well-child care services in the county.
Research Institute, Mary Imogene Bassett Hospital, Cooperstown, NY, USA. gadomski@usa.net
A M
AM
Gadomski
J
J
Talarico
K S
KS
Abernethy
H G
HG
Cicirello
D002662:Child Health Services / Q000592:standards* / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008499:Medical Records; D009518:New York / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data