title: An enriched medical home intervention using community health workers improves adherence to immunization schedules.
abstract: OBJECTIVE
  Disparities in childhood vaccination rates persist.
  
  
  OBJECTIVE
  To evaluate the impact of an enriched medical home intervention using community health workers on improving immunization adherence among young children.
  
  
  METHODS
  The intervention group received home visits from trained community health workers to support families in adhering to recommended care while the comparison group received usual care (i.e. no home visits/reminders). Immunization history and socio-demographic data were collected using medical records and a validated questionnaire. The doubly robust estimation of risk difference, which combines weighting via propensity score and outcome regression model, was used to compare immunization adherence rates between two groups.
  
  
  METHODS
  Primary care practices affiliated with a suburban tertiary care academic medical center serving a socioeconomically diverse population.
  
  
  METHODS
  The study sample included children ≤ 2 years of age at enrollment who crossed at least one age time point of 3, 7, 15, or 24 months during their 6 months post-enrollment period.
  
  
  METHODS
  The primary outcome was age-specific immunization up-to-date status defined by CDC guidelines. The primary predictor was participation in the intervention.
  
  
  RESULTS
  The analysis included 201 children in the usual care group and 110 children in the intervention group. The usual care and intervention groups were divided into subgroups of newborn and infant/toddler to account for prior immunization history. After adjusting for differences in group characteristics, we found a significant absolute increase in the up-to-date immunization likelihood for both newborns (20.9%, p=0.01) and infants/toddlers (16.8%, p=0.01) receiving the intervention when compared to their peers receiving usual clinical care.
  
  
  CONCLUSIONS
  Our findings demonstrate the positive impact of an enriched medical home intervention using community health worker home visitation on early childhood immunization up-to-date status. With further study, this model may provide a cost-effective approach to improving childhood vaccination rates, especially for vulnerable groups.
authors.affiliation: Department of Pediatrics, Stony Brook University, Stony Brook, NY, United States. Electronic address: susmita.pati@stonybrook.edu.
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.affiliation: Department of Pediatrics, Stony Brook University, Stony Brook, NY, United States.
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Ladowski
authors.affiliation: Department of Pediatrics, Stony Brook University, Stony Brook, NY, United States.
authors.forename: Angie T
authors.initials: AT
authors.lastname: Wong
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, United States.
authors.forename: Jiayu
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Preventive Medicine, Stony Brook University , Stony Brook, NY, United States.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003150:Community Health Workers; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055118:Medication Adherence; D018802:Patient-Centered Care; D011320:Primary Health Care; D017010:Reminder Systems; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines
keywords: Community health worker; Early childhood; Primary care medical home; Vaccination