Parental satisfaction with early pediatric care and immunization of young children - The mediating role of age-appropriate well-child care utilization

Objective: To prospectively evaluate the impact of parental satisfaction on childhood immunization and the mediating role of age-appropriate well-child care. Design: Secondary analyses of cohort data from the National Evaluation of Healthy Steps for Young Children. Data sources included an enrollment questionnaire, parent interview at 2 to 4 months, and medical records. Setting: Twenty-four pediatric practices across the United States. Participants: A total of 4896 (85%) of the initial 5565 enrolled families who were interviewed at 2 to 4 months and had abstracted medical records. Main Exposure: Parental satisfaction with overall pediatric care assessed at 2 to 4 months as excellent, good, or fair/poor. Main Outcome Measures: Age-appropriate first dose of diphtheria-tetanus-pertussis; third dose of diphtheria-tetanus-pertussis; and measles, mumps, and rubella vaccinations; and up-to-date vaccinations at 24 months ( 4 diphtheria-tetanus-pertussis, 3 polio, and 1 measles, mumps, and rubella). Results: The majority of parents were satisfied with their child's health care; only 4% rated overall care as fair or poor. Children whose parents reported fair/poor satisfaction with care had a reduced odds of receiving age-appropriate first dose of diphtheria-tetanuspertussis vaccination ( odds ratio, 0.43; 95% confidence interval, 0.28-0.67); third dose of diphtheria-tetanuspertussis vaccination ( odds ratio, 0.52; 95% confidence interval, 0.36-0.74); and measles, mumps, and rubella vaccination ( odds ratio, 0.58; 95% confidence interval, 0.37-0.92); and of being up to date by 24 months ( odds ratio, 0.65; 95% confidence interval, 0.43-0.99) compared with children whose parents reported excellent care, independent of sociodemographic and maternal health care utilization variables. The negative effect of fair/poor satisfaction on immunization was largely explained by reduced utilization of age-appropriate well-child care. Conclusion: Quality assurance activities that assess parental satisfaction with care may have added value in identifying children who are less likely to receive timely preventive services.