Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 898-905 (doi:10.1542/peds.2007-2174)

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ARTICLE

Impact of Immunization at Sick Visits on Well-Child Care

Alexander G. Fiks, MD, MSCE^a,b,c, Kenya F. Hunter, MPH^b,c, A. Russell Localio, PhD^d, Robert W. Grundmeier, MD^a,c and Evaline A. Alessandrini, MD, MSCE^a,b,c

^a Pediatric Research Consortium
^b Pediatric Generalist Research Group, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of
^c Pediatrics
^d Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

OBJECTIVE. We assessed the impact of immunization at sick visits on subsequent and overall well-child care.

METHODS. We performed a retrospective cohort study using electronic health record data from 4 urban practices affiliated with an academic medical center. Participants included all children born between September 1, 2003, and July 31, 2004, with a visit at a study practice before 6 weeks of age and 1 sick visit (n = 1675). The main outcome measures were (1) attendance at a well-child visit within 60 days after an index sick visit by children due for vaccines and preventive care and (2) the overall number of well-child visits kept by children between 6 weeks and 13 months of age.

RESULTS. Among all demographic and health-related factors considered, immunization receipt at a sick visit was associated most strongly with decreased subsequent well-child care. Among children already delayed (late) for vaccines, 31% returned for well-child care if immunizations were given at eligible sick visits, compared with 47% of those who received no vaccines (risk difference, with adjustment for covariates: –16%). Among those without immunization delay, 42% of children who received vaccines returned for well-child care, compared with 73% of those who received no vaccines (risk difference: –31%). Although 5 well-child visits are recommended, children with no immunizations at sick visits had an adjusted predicted number of 3.8 well-child visits, those with 1 sick visit with immunizations had 3.3 visits, and those with 2 sick visits with immunizations had 2.8 visits between 6 weeks and 13 months of age.

CONCLUSIONS. Immunization at sick visits was associated with decreased rates of well-child care, especially among those without previous vaccine delay. This strong association between immunization at sick visits and well-child care should be considered in any plan to restructure pediatric preventive care.

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Key Words: immunization assessment • medical informatics • quality improvement • urban

Abbreviations: CI—confidence interval

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Accepted Sep 14, 2007.

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