Early continuity of care and immunization coverage.
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.
Irigoyen
Matilde
M
Division of General Pediatrics, Department of Pediatrics, Columbia University, New York, NY 10032, USA. mi5@Columbia.edu
Findley
Sally E
SE
Chen
Shaofu
S
Vaughan
Roger
R
Sternfels
Pamela
P
Caesar
Arturo
A
Metroka
Amy
A
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