title: Does closure of children's medical home impact their immunization coverage?
abstract: OBJECTIVE
  Little is known about the impact closing a health care facility has on immunization coverage of children utilizing that facility as a medical home. The authors assessed the impact of closing a Medicaid managed care facility in Philadelphia on immunization coverage of children, primarily low income children from racial/ethnic minority groups, utilizing that facility for routine immunizations.
  
  
  METHODS
  Observational longitudinal cohort case study.
  
  
  METHODS
  Eligible children were born 03/01/05-06/30/07, present in Philadelphia's immunization information system (IIS), and were active clients of the facility before it closed in September 2007. IIS-recorded immunization coverage at ages 5, 7, 13, 16 and 19 months through January 2009 was compared between clinic children age-eligible to receive specific vaccines before clinic closing (preclosure cohorts) and children not age-eligible to receive those vaccines prior to closing (postclosure cohorts).
  
  
  RESULTS
  Of 630 eligible children, 99 (16%) had no additional IIS-recorded immunizations. Third dose DTaP vaccine coverage at age seven months among preclosure cohorts was 54.4% vs. 40.3% among postclosure cohorts [risk ratio 1.31 (1.15,1.49)]. Fourth dose DTaP coverage at 19 months was 65.9% vs. 57.7% [risk ratio 1.24 (1.08,1.42)]. MMR coverage at 16 months was 79.5% vs. 69.9% [risk ratio 1.47 (1.22, 1.76)]. Coverage for the 431331 vaccination series at 19 months was 63.8% vs. 53.8% [risk ratio 1.28 (1.12,1.88)].
  
  
  CONCLUSIONS
  Immunization coverage declined at key age milestones for active clients of a Medicaid managed care that closed as compared with preclosure cohorts of clients from the same facility. When a primary health care facility closes, efforts should be made to ensure that children who had received vaccinations at that facility quickly establish a new medical home.
authors.affiliation: Health Services Research and Evaluation Branch, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, A19, Atlanta, GA 30333, USA. Electronic address: mkolasa@cdc.gov.
authors.forename: M S
authors.initials: MS
authors.lastname: Kolasa
authors.affiliation: Health Services Research and Evaluation Branch, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, A19, Atlanta, GA 30333, USA. Electronic address: jxs7@cdc.gov.
authors.forename: J
authors.initials: J
authors.lastname: Stevenson
authors.affiliation: Philadelphia Department of Public Health, 500 S Broad St, 2nd Floor, Philadelphia, PA 19146, USA. Electronic address: Alexandra.Ossa@phila.gov.
authors.forename: A
authors.initials: A
authors.lastname: Ossa
authors.affiliation: Program Operations Branch, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, A19, Atlanta, GA 30333, USA. Electronic address: James.Lutz@phila.gov.
authors.forename: J
authors.initials: J
authors.lastname: Lutz
mesh_terms: D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D006271:Health Facility Closure; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D007223:Infant; D008484:Medicaid; D008913:Minority Groups / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration*; D015143:Philadelphia; D011203:Poverty; D044469:Racial Groups / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States
keywords: Children/adolescents; Health disparities; Health services; Immunization; Minority health