Immunizations in children with special health care needs in a medical home model of care.
OBJECTIVE
To assess whether a model of care with augmented services within an existing medical home could improve immunization rates for Children with Special Health Care Needs (CSHCN) and to evaluate the influence of family and practice characteristics on these children's immunization rates.


METHODS
Participants were six general pediatric practices, CSHCN, and their families. Enhancements were added to the medical home for CSHCN, including additional nurse practitioner time. A prospective survey and chart review of volunteer families was made in 1998 repeating the chart review in 2000.


RESULTS
The immunization rates of CSHCN in the practices before the intervention was 83.4% for DTaP, polio and MMR and 80% if HIB and HepB were added. The intervention did not improve these already high rates. In regression models, children with late onset disorders were more likely NOT to be up-to-date (UTD) by 2 years of age (OR 3.29). CSHCN cared for by non-birth parents and CSHCN whose family incomes were greater than $40,000 per year were also more likely NOT to be UTD (OR 3.81, 2.75 respectively) as were patients of providers not satisfied with any aspect of serving patients (OR 3.29).


CONCLUSIONS
In these practices already committed to a medical home model of care for CSHCN, immunization rates were at or above state and national averages before any intervention took place. Some groups of patients among these CSHCN were more likely to be delayed with immunizations, including those with late onset disorders and those with high family incomes.
Samuels
Ronald C
RC
Division of General Pediatrics, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. ronald.samuels@childrens.harvard.edu
Liu
Jihong
J
Sofis
Lisa A
LA
Palfrey
Judith S
JS
D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration*; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008297:Male; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care; D013022:South Carolina