PEDIATRICS Vol. 116 No. 1 July 2005, pp. 130-139 (doi:10.1542/peds.2004-1058)
The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program
From the Centers for Disease Control and Prevention, National Immunization Program, Atlanta, Georgia
Background. The Vaccines for Children (VFC) program is designed to reduce the cost of vaccines for vulnerable children, including Medicaid-eligible children, American Indian/Alaska Native children, uninsured children, and underinsured children whose health insurance does not cover the cost of vaccinations. A desired consequence of the program is to promote comprehensive continuous medical care within a medical home for these children.
Objectives. To explore how having a medical home is associated with vaccination coverage among children eligible for the program.
Participants. A total of 24514 children 19 to 35 months of age sampled by the National Immunization Survey.
Design. VFC eligibility was evaluated for 24514 children 19 to 35 months of age who were sampled by the National Immunization Survey. Children were considered to have a medical home if they had a doctor, nurse, or physician's assistant who provided them with ongoing routine care, including well-child care, preventive care, and sick care, according to their parents. Sampled children were determined to be 4:3:1:3:3 up-to-date (UTD) if their vaccination providers reported administering 
4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, 3 doses of polio vaccine, 1 dose of measles-mumps-rubella vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine.
Results. Nationally, 44.9% of all children were VFC eligible and 93.0% of the VFC-eligible children received all vaccine doses at a provider enrolled in the VFC program. Compared with children who were not VFC eligible, VFC-eligible children were less likely to be UTD (70.8% vs 77.7%) and less likely to have a medical home (82.1% vs 95.0%). However, among VFC-eligible children, children who had a medical home were significantly more likely to be UTD, compared with children who did not have a medical home (72.3% vs 63.5%). Also, among VFC-eligible children who had a medical home, children who used their medical home consistently to receive all of their vaccination doses were significantly more likely to be UTD, compared with children who did not receive all of their doses from their medical home (75.3% vs 65.7%). Finally, the 4:3:1:3:3 vaccination coverage rate among VFC-eligible children who received all of their vaccination doses from their medical home was not significantly different from that among non-VFC-eligible children, after controlling for significant differences in sociodemographic factors between these groups (adjusted difference: 2.8%; 95% confidence interval: –0.1% to 5.7%).
Conclusions. Although the vaccination coverage rate among VFC-eligible children who had a medical home and received all vaccine doses from their medical home was essentially equivalent to that of non-VFC-eligible children, substantial percentages of VFC-eligible children either did not have a medical home or did not use their medical home to receive all of their recommended vaccinations. The vaccination coverage rate among these children was significantly lower. This suggests that there may be opportunities to increase vaccination coverage by removing barriers that prevent the adoption and consistent use of a medical home among these children.
Key Words: medical home • survey • relative risk • vaccination coverage
Abbreviations: CI, confidence interval • NIS, National Immunization Survey • RDD, random-digit dialing • UTD, up-to-date • VFC, Vaccines for Children • MSA, metropolitan statistical area • SCHIP, State Children's Health Insurance Program • CASRO, Council of American Survey Research Organizations • 4:3:1:3:3, 4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, 3 doses of polio vaccine, 1 dose of measles-mumps-rubella vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine • HIM, Health Insurance Module
Accepted Jan 6, 2005.
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