title: 'Parsimonious' versus patient-centered care: quality issues in childhood immunization.
abstract: As currently practiced, the standard of care strictly limiting the number of medical conditions that warrant withholding vaccination may be incompatible with the Institute of Medicine's (IOM) recommendation for patient-centered care. Furthermore, the "parsimonious" approach to accepting contraindications to vaccination is inconsistent with the IOM's recommendation to consider alternative vaccination schedules and policies aimed at redistributing the benefits and burdens of immunization. This critical perspective is examined within the framework of five rules proposed by the IOM. There is an opportunity to improve the quality of childhood immunization by adopting a patient-centered approach, identifying individuals at risk for acute and/or delayed adverse vaccine effects, and developing alternative immunization schedules for these high-risk children.
authors.affiliation: cgallagher@med.miami.edu
authors.forename: Carolyn
authors.initials: C
authors.lastname: Gallagher
mesh_terms: D001321:Autistic Disorder / Q000139:chemically induced; D002675:Child, Preschool; D003657:Decision Making; D017408:Guidelines as Topic; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D007223:Infant; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D018802:Patient-Centered Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D014481:United States; D014612:Vaccines / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014612:Vaccines