POPULATION-BASED STUDY OF THE ADEQUACY OF WELL-CHILD CARE SERVICES - A RURAL COUNTY REPORT CARD

Objective: To determine the adequacy of well-child care services using a population-based study. Design: The medical records of all county p roviders and the immunization records at the local health department w ere reviewed. A county birth cohort, identified using electronic birth certificates, was compared with those who migrated into the area (her eafter, immigrants). Setting: All primary care sites (private, network , etc) in a rural county. Patients: Two-year-old children born between May 31, 1993, and May 30, 1994. Main Outcome Measures: Immunization r ates and preventive screenings. Results: A total of 674 medical record s were reviewed. Of these, 377 (56%) belonged to a county birth cohort and 297 (44%) were in-migrants. Medical records of 64% of the birth c ohort were reviewed. Among all 2-year-olds, 80% received 4 doses of di phtheria and tetanus toxoids and pertussis vaccine; 89%, 3 doses of Ha emophilus influenzae type b (Hib); 75%, 4 doses of Hib; 77%, 3 doses o f hepatitis B vaccine; 85%, measles-mumps-rubella vaccine; 85%, 3 dose s of oral poliovirus vaccine; 17%, varicella live virus vaccine (Variv ax). The 4:3:1 rate was 75% at age 2 years. Sixty-eight percent had ha d 1 hematocrit, 74% had 1 lead screening test, and 43% had 2 lead scre ening tests. A total of 64% had had 6 well-child visits and 30% had ha d 9. The mean number of weights and heights measured was 4.8 and 4.5, respectively, at age 1 year and 7.3 and 6.8, respectively, at age 2 ye ars. The birth cohort had notably higher rates of documented immunizat ion and preventive screening than in-migrants. Conclusions: This study demonstrated immunization coverage at or below the national average, and well-child care service provisions below American Academy of Pedia trics standards at a county level. This study enabled individual prima ry care sites to assess their well-child care provision and provided a useful baseline for targeting the improvement of well-child care serv ices in the county.