Abstract 32 Health Services Research: Access and Organization Poster Symposium, Saturday, 5/1

Objective: To test the effectiveness of the Denver Child Health Passport, a parent-held/provider completed/community - tracked health maintenance record, for promoting use of the preventative medical services provided in a comprehensive adolescent-oriented teen-maternity program. We hypothesized that Passport recipients would be more compliant with well visits and hence less apt to: 1) be under-immunized; 2) have clinic visits at which immunizations were missed; 3) visit the emergency department (ED); and 4) have repeat pregnancies.

Method: Passports (N=71) were allocated randomly in a poor (92% medicaid-users), racially diverse, group of 188 consecutively delivered teen mothers (17 ± 2 yrs) of ≤ 2 mo-olds who were cared for with their children in a special teen-maternity program.

Results: Of the 188 participants 129 (69%) remained in the practice ≥ 6 mos and 92 (49%) remained ≥24 mos. Passport use was negligible except at well visits. Passports were used at 66% of well visits for the first 6 mos, 31% of well visits for the next 6 mos, and rarely thereafter. The passport and controls groups did not differ significantly with respect to background or the four outcome variables. Immunizations were up-to-date for age in 83% v 87% of 9-mo-olds and 89% v 96% of 24-mo-olds, respectively. During the first 6 mos, when passport use was maximal, ED-visits averaged 1.2 v 0.7 and immunization opportunities were missed at 4% v 1% of clinic visits, respectively for the passport and control groups. Over the next 6 mos ED-visits averaged 1 v 0.5 and immunizations were missed at 8% v 3% of clinic visits, respectively. The repeat pregnancy rate was 14% at 1 yr and 35% at 2 yrs. Mothers of fully immunized 15 mo-olds were less apt to become pregnant again during the first two postpartum years (19% v 53%; p=.03). Although the teens were initially enthusiastic about the passports, only 34% used them at ≥80% of well visits during the first 6 mos. Even this high passport-use group did not make better use of preventive medical services or differ significantly from controls with respect to the four outcome variables.

Conclusions: The study hypothesis was not supported. We speculate that a parent-held medical record failed to promote the use of preventative medical care in this population because: 1) most teens used the passport sporadically and 2) with comprehensive, teen-oriented, mother-baby care most parents were already able to achieve Year 2000 immunization goals. In this population, under-immunized children should alert pediatric providers to the mother's increased risk of repeat conception.