KEYWORD1:
Immunization coverage, continuity of care, utilization of services

BACKGROUND:
The relationship between continuity of care and immunization outcome has been studied mainly from a cross-sectional perspective, but few studies have used a longitudinal perspective.

OBJECTIVE:
To examine the impact of duration of continuity of care on immunization status

METHOD:
We followed a random sample of 842 children at eleven practices in two low-income, minority communities in NYC until age 3 years. For this analysis we included only 641 children who started care before 90 days and had at least 2 visits. Visit history and immunization data were obtained from medical records until age 3. Supplementary immunization data were provided by NYCDOH Immunization Registry. Time in care was the duration between birth and their last visit before age 3. Outcome measures were immunization status at 24 months (UTD 24) and cumulative time UTD.

RESULT:
For every additional month children remained in care, they were 13% more likely to be UTD at 24 months of age (p<.001). Children in care for >15 months were 10.6 times more likely to be UTD at 24 months than those in care <6 months. By 15 months, 78% of the children UTD at 24 months were still in care, compared with only 36% of the not UTD group.

CONCLUSION:
The duration of time in care has a lasting impact on immunization outcomes. Interventions that facilitate and promote children’s use of the medical home over a prolonged period of time are critical to achieve national immunization goals.
LEARNINGOBJECTIVES:
Longitudinal perspective on continuity of care and immunization outcome.