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. 2000 Jun;90(6):962–965. doi: 10.2105/ajph.90.6.962

The association between greater continuity of care and timely measles-mumps-rubella vaccination.

D A Christakis 1, L Mell 1, J A Wright 1, R Davis 1, F A Connell 1
PMCID: PMC1446264  PMID: 10846516

Abstract

OBJECTIVES: This study assessed whether greater continuity of care is associated with timely administration of measles-mumps-rubella (MMR) vaccination. METHODS: We studied 11,233 patients continuously enrolled in Group Health Cooperative (GHC) from birth to 15 months. We used a preestablished index to quantify continuity of care based on the number of primary care providers in relation to the number of clinic visits. MMR vaccination status at 15 months was assessed with automated immunization data systems at GHC. RESULTS: In a logistic regression model, both medium continuity (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.08, 1.33) and high continuity (OR = 1.36, 95% CI = 1.22, 1.52) were associated with increased likelihood of being immunized by 15 months compared with patients in the lowest tercile of continuity of care. CONCLUSION: Greater continuity of care is associated with more timely immunization.

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Selected References

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  1. Alpert J. J., Kosa J., Haggerty R. J., Robertson L. S., Heagarty M. C. Attitudes and satisfactions of low-income families receiving comprehensive pediatric care. Am J Public Health Nations Health. 1970 Mar;60(3):499–506. doi: 10.2105/ajph.60.3.499. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alpert J. J., Robertson L. S., Kosa J., Heagarty M. C., Haggerty R. J. Delivery of health care for children: report of an experiment. Pediatrics. 1976 Jun;57(6):917–930. [PubMed] [Google Scholar]
  3. Bice T. W., Boxerman S. B. A quantitative measure of continuity of care. Med Care. 1977 Apr;15(4):347–349. doi: 10.1097/00005650-197704000-00010. [DOI] [PubMed] [Google Scholar]
  4. Blankfield R. P., Kelly R. B., Alemagno S. A., King C. M. Continuity of care in a family practice residency program. Impact on physician satisfaction. J Fam Pract. 1990 Jul;31(1):69–73. [PubMed] [Google Scholar]
  5. Bordley W. C., Freed G. L., Garrett J. M., Byrd C. A., Meriwether R. Factors responsible for immunizations referrals to health departments in North Carolina. Pediatrics. 1994 Sep;94(3):376–380. [PubMed] [Google Scholar]
  6. Charney E., Bynum R., Eldredge D., Frank D., MacWhinney J. B., McNabb N., Scheiner A., Sumpter E. A., Iker H. How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics. 1967 Aug;40(2):188–195. [PubMed] [Google Scholar]
  7. Christakis D. A., Feudtner C. Temporary matters. The ethical consequences of transient social relationships in medical training. JAMA. 1997 Sep 3;278(9):739–743. doi: 10.1001/jama.278.9.739. [DOI] [PubMed] [Google Scholar]
  8. Christakis D. A., Wright J. A., Koepsell T. D., Emerson S., Connell F. A. Is greater continuity of care associated with less emergency department utilization? Pediatrics. 1999 Apr;103(4 Pt 1):738–742. doi: 10.1542/peds.103.4.738. [DOI] [PubMed] [Google Scholar]
  9. Ettner S. L. The timing of preventive services for women and children: the effect of having a usual source of care. Am J Public Health. 1996 Dec;86(12):1748–1754. doi: 10.2105/ajph.86.12.1748. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Freed G. L., Bordley W. C., DeFriese G. H. Childhood immunization programs: an analysis of policy issues. Milbank Q. 1993;71(1):65–96. [PubMed] [Google Scholar]
  11. Goldstein K. P., Kviz F. J., Daum R. S. Accuracy of immunization histories provided by adults accompanying preschool children to a pediatric emergency department. JAMA. 1993 Nov 10;270(18):2190–2194. [PubMed] [Google Scholar]
  12. Gordis L., Markowitz M. Evaluation of the effectiveness of comprehensive and continuous pediatric care. Pediatrics. 1971 Nov;48(5):766–776. [PubMed] [Google Scholar]
  13. Hinman A. R., Orenstein W. A., Mortimer E. A., Jr When, where, and how do immunizations fail? Ann Epidemiol. 1992 Nov;2(6):805–812. doi: 10.1016/1047-2797(92)90074-z. [DOI] [PubMed] [Google Scholar]
  14. Holt E., Guyer B., Hughart N., Keane V., Vivier P., Ross A., Strobino D. The contribution of missed opportunities to childhood underimmunization in Baltimore. Pediatrics. 1996 Apr;97(4):474–480. [PubMed] [Google Scholar]
  15. Lannon C., Brack V., Stuart J., Caplow M., McNeill A., Bordley W. C., Margolis P. What mothers say about why poor children fall behind on immunizations. A summary of focus groups in North Carolina. Arch Pediatr Adolesc Med. 1995 Oct;149(10):1070–1075. doi: 10.1001/archpedi.1995.02170230024003. [DOI] [PubMed] [Google Scholar]
  16. Lieu T. A., Smith M. D., Newacheck P. W., Langthorn D., Venkatesh P., Herradora R. Health insurance and preventive care sources of children at public immunization clinics. Pediatrics. 1994 Mar;93(3):373–378. [PubMed] [Google Scholar]
  17. Lynch M. Effect of practice and patient population characteristics on the uptake of childhood immunizations. Br J Gen Pract. 1995 Apr;45(393):205–208. [PMC free article] [PubMed] [Google Scholar]
  18. Mullooly J., Drew L., DeStefano F., Chen R., Okoro K., Swint E., Immanuel V., Ray P., Lewis N., Vadheim C. Quality of HMO vaccination databases used to monitor childhood vaccine safety. Vaccine Safety DataLink Team. Am J Epidemiol. 1999 Jan 15;149(2):186–194. doi: 10.1093/oxfordjournals.aje.a009785. [DOI] [PubMed] [Google Scholar]
  19. Rodewald L. E., Szilagyi P. G., Shiuh T., Humiston S. G., LeBaron C., Hall C. B. Is underimmunization a marker for insufficient utilization of preventive and primary care? Arch Pediatr Adolesc Med. 1995 Apr;149(4):393–397. doi: 10.1001/archpedi.1995.02170160047007. [DOI] [PubMed] [Google Scholar]
  20. Starfield B. H., Simborg D. W., Horn S. D., Yourtee S. A. Continuity and coordination in primary care: their achievement and utility. Med Care. 1976 Jul;14(7):625–636. doi: 10.1097/00005650-197607000-00008. [DOI] [PubMed] [Google Scholar]
  21. Starfield B., Simborg D., Johns C., Horn S. Coordination of care and its relationship to continuity and medical records. Med Care. 1977 Nov;15(11):929–938. doi: 10.1097/00005650-197711000-00007. [DOI] [PubMed] [Google Scholar]
  22. Steinwachs D. M. Measuring provider continuity in ambulatory care: an assessment of alternative approaches. Med Care. 1979 Jun;17(6):551–565. doi: 10.1097/00005650-197906000-00001. [DOI] [PubMed] [Google Scholar]
  23. Szilagyi P. G., Rodewald L. E., Humiston S. G., Hager J., Roghmann K. J., Doane C., Cove L., Fleming G. V., Hall C. B. Immunization practices of pediatricians and family physicians in the United States. Pediatrics. 1994 Oct;94(4 Pt 1):517–523. [PubMed] [Google Scholar]
  24. Szilagyi P. G., Rodewald L. E., Humiston S. G., Raubertas R. F., Cove L. A., Doane C. B., Lind P. H., Tobin M. S., Roghmann K. J., Hall C. B. Missed opportunities for childhood vaccinations in office practices and the effect on vaccination status. Pediatrics. 1993 Jan;91(1):1–7. [PubMed] [Google Scholar]
  25. Zhang J., Yu K. F. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998 Nov 18;280(19):1690–1691. doi: 10.1001/jama.280.19.1690. [DOI] [PubMed] [Google Scholar]

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