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Does closure of children's medical home impact their immunization coverage?
M S Kolasa1, J Stevenson1, A Ossa2
1Health 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.
Insights
Closing a healthcare facility led to decreased childhood immunization rates, particularly for low-income and minority children. Establishing a new medical home quickly is crucial after facility closures to maintain vaccination schedules.
Area of Science:
- Pediatric Health
- Public Health Policy
- Health Services Research
Background:
- The impact of healthcare facility closures on child immunization coverage is not well understood.
- Medicaid managed care facilities serve vulnerable populations, including low-income children and racial/ethnic minorities.
Purpose of the Study:
- To assess the effect of a Medicaid managed care facility closure in Philadelphia on the immunization coverage of its young patients.
- To identify potential disparities in immunization rates following the closure.
Main Methods:
- An observational, longitudinal cohort case study design was employed.
- Children born between March 2005 and June 2007, utilizing the facility before its September 2007 closure, were included.
- Immunization Information System (IIS) data were compared between children eligible for vaccines before closure (preclosure cohorts) and those not eligible (postclosure cohorts).
Main Results:
- Third dose DTaP vaccine coverage at seven months was significantly lower in postclosure cohorts (40.3%) compared to preclosure cohorts (54.4%).
- MMR coverage at 16 months and the 431331 vaccination series at 19 months also showed reduced rates in postclosure cohorts.
- Overall, 16% of eligible children had no further immunizations recorded in the IIS after the facility closure.
Conclusions:
- The closure of the Medicaid managed care facility resulted in a decline in immunization coverage at key developmental milestones for its former patients.
- Prompt establishment of a new medical home is essential for children previously served by a closed healthcare facility to ensure continuity of care and vaccination.
- Findings highlight the need for proactive strategies to mitigate the impact of healthcare facility closures on pediatric immunization rates, especially in underserved communities.
Objectives:
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.
Study Design:
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.
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