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-tetanus-pertussis vaccination (odds ratio, 0.43; 95% confidence interval, 0.28-0.67); third dose of diphtheria-tetanus-pertussis 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.