Physician credentials and practices associated with childhood immunizationrates: Private practice pediatricians serving poor children in New York City

Private practice physicians in New York City's poorest neighborhoods are ty pically foreign trained, have generally substandard clinical practices, and have been accused of rushing Medicaid patients through to turn a profit. H owever, they also represent a sizable share of physician capacity in medica lly underserved neighborhoods. This article documents the level of credenti als, systems, and immunization-related procedures among these physicians. F urthermore, it assesses the relationship between such characteristics and c hildhood immunization rates. The analysis utilizes a cross-sectional compar ison of immunization rates in 60 Private practices that submitted 2,500 or more Medicaid claims for children. Immunization data were gathered from med ical records for 2,948 randomly selected children under 3 years of age. Hal f of sampled physicians were board certified (55%), and half were accepted by the Medicaid Preferred Physicians and Children (PPAC) program (51.7%). O f physicians, 43% saw patients only on a walk-in basis, while only 17% sche duled the next appointment while the patient was still in the office. There were 75% of the physicians who reported usually immunizing at acute care v isits. Immunization rates were higher among PPAC physicians compared to oth ers (41% vs. 29% up to date for diptheria and tetanus toxoids and pertussis [DTP]/Haemophilus influenzae type b [Hib], polio, and measles-mumps-rubell a [MMR], P = .01), and board-certified physicians shouted a trend toward be tter immunization rates (39% vs. 30%, P = .07). Physicians who reported usu ally immunizing at acute care visits also had higher rates than those who d id not (38% vs. 27%, P = .05). Scheduling a date and time for the next immu nization showed a trend reward association with immunization coverage (37% vs. 28%, P = .10). Private practice physicians who provide high volumes of care reimbursed by Medicaid have improved their credentials and affiliation s over rime, thereby expanding reimbursement options. Credentials and affil iations were at least as effective in distinguishing relatively high- and l ow-performing physicians, as were immunization-related practices, suggestin g that they are useful markers for higher quality care. The relative succes s of the PPAC program should inform efforts to improve the capacity and qua lity of primary care for vulnerable children. Appointment and reminder syst ems that effectively manage the flow of children back into the office for i mmunizations and the vigilant use of acute care visits for immunizations go hand in hand. Opportunity exists for payers and plans to encourage and sup port these actions.