title: Parental satisfaction with early pediatric care and immunization of young children: the mediating role of age-appropriate well-child care utilization.
abstract: OBJECTIVE
  To prospectively evaluate the impact of parental satisfaction on childhood immunization and the mediating role of age-appropriate well-child care.
  
  
  METHODS
  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.
  
  
  METHODS
  Twenty-four pediatric practices across the United States.
  
  
  METHODS
  A total of 4896 (85%) of the initial 5565 enrolled families who were interviewed at 2 to 4 months and had abstracted medical records.
  
  
  METHODS
  Parental satisfaction with overall pediatric care assessed at 2 to 4 months as excellent, good, or fair/poor.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. aschempf@jhsph.edu
authors.forename: Ashley H
authors.initials: AH
authors.lastname: Schempf
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Minkovitz
authors.forename: Donna M
authors.initials: DM
authors.lastname: Strobino
authors.forename: Bernard
authors.initials: B
authors.lastname: Guyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002654:Child Care / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D007114:Immunization / Q000592:standards*; D010290:Parents; D017060:Patient Satisfaction; D011446:Prospective Studies; D011785:Quality Assurance, Health Care