Increasing Infant Preventive Health Service Delivery in an Inner City Population

The overall aim of the proposed project is to increase receipt of a broad array of childhood
preventive health services in a population of disadvantaged inner city children. Specific
hypotheses concerning risk factors for infant under-immunization and lack of receipt of well
child care will be tested. This study will first examine these risk factors in a defined
population of inner city children, using a historical cohort. Finally, through the use of a
randomized controlled trial in a prospective birth cohort, it will test an intervention,
based partly on the evidence gathered from the initial study phases, to increase
immunization rates and well child care delivery in those children most at risk for “falling
through the cracks.” These studies will be conducted in the Denver Health community health
network, the largest integrated community health care system in the United States.

Information gathered via rigorous exploration of risk factors for inadequate preventive
service receipt in inner city children is especially important at present, because despite
rising immunization rates around the country, it is clear that “pockets of need” remain in
many urban locations. Children in these pockets of need, in addition to being
under-immunized, also are at higher risk for lack of other preventive services, and suffer
from higher rates of iron deficiency anemia and lead poisoning. The knowledge gained from
both the descriptive and interventional parts of the study will provide crucial information
for physicians who care for these children, health care systems that serve them, and policy
makers responsible for promoting effective tools and funding their implementation. The
information gained herein will also provide important methodological insight for generalists
who wish to conduct interventional studies in large urban populations, by further refining
existing methods used in design and implementation of large cohort studies in disadvantaged
children.

Although this project will be conducted among a population of disadvantaged inner city
children, many of the findings from these studies will likely be applicable in health care
systems that serve other socioeconomic groups. All primary care physicians who care for
children face the challenge of trying to boost childhood immunization rates over 90%, and to
increase the delivery of a full spectrum of preventive health services to children. The
investigators hope that the evidence from this project will inform and shape both the
clinical practice of individual health care providers and health care systems charged with
providing preventive health care to children in a wide variety of settings.

Inclusion Criteria:

- Any child born at Denver Health Medical Center between 2/1/04 and 1/31/05 who
receives primary care at one of 3 community health centers.

Exclusion Criteria:

- No medical care in the Denver Health community health system after 42 days of age.

- Birthweight less than 1500 grams.