title: Early continuity of care and immunization coverage.
abstract: OBJECTIVE
  We examined the relationship between early and exclusive continuity of care at the initial source of care and immunization coverage.
  
  
  METHODS
  We used a cohort study design with 641 randomly selected children initiating care before 3 months and making 2 or more visits to an inner-city practice network. We used 2 complementary data sources: medical records and the New York City Department of Health Citywide Immunization Registry. Immunization measures were cumulative age appropriate and up-to-date at 18 months (UTD18).
  
  
  RESULTS
  There was a gradual attrition from the initial source of care. By 18 months, less than half the children (46%) remained in care. Regardless of continuity, nearly half (42%) had used other immunization providers. The initial source of care contributed most immunizations (89%-94%); however, across all levels of continuity, children who also used other providers had higher immunization rates. We found a threshold effect of continuity beginning at 12 months: children in care from 12 to 14 months were 17.5 times more likely to be UTD18 than those in care less than 6 months. Each additional period in care increased the time remaining current with immunizations. Among children UTD18, 88% were in care at 11 months compared with 38% among those not UTD18, a 50% difference.
  
  
  CONCLUSIONS
  Continuity of care at the initial source of care had a significant and lasting impact on immunization coverage, even if not used exclusively. Interventions promoting continued use of the medical home over the first 2 years of life may help improve immunization coverage.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Columbia University, New York, NY 10032, USA. mi5@Columbia.edu
authors.forename: Matilde
authors.initials: M
authors.lastname: Irigoyen
authors.forename: Sally E
authors.initials: SE
authors.lastname: Findley
authors.forename: Shaofu
authors.initials: S
authors.lastname: Chen
authors.forename: Roger
authors.initials: R
authors.lastname: Vaughan
authors.forename: Pamela
authors.initials: P
authors.lastname: Sternfels
authors.forename: Arturo
authors.initials: A
authors.lastname: Caesar
authors.forename: Amy
authors.initials: A
authors.lastname: Metroka
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D009519:New York City