Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Well Baby Care and Immunizations

Summer 2004

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Size of the Problem

Over 68,000 babies are born in Minnesota each year according to Minnesota health statistics [1]. All Minnesota infants are in need of regular well child check-ups and age appropriate immunizations. Preventive health care can detect and treat conditions early and promote healthy development, nutrition and infant safety.

All Minnesota infants are required to be immunized by state law or have parental/guardian waiver of vaccination prior to school entry. There are no state legal requirements for well child check-ups.

Seriousness

People affected by infant immunizations and well baby care
The rates of childhood immunizations have been steadily increasing in Minnesota and are approaching the Minnesota 2004 goal of 90% up-to-date. Data from the 2001 Retrospective Kindergarten Survey indicate that 81% of all Minnesota children were up-to-date at 24 months of age [2]. However, significant portions of Minnesota’s diverse communities and select cities/counties are substantially below the state target goal. The US 2010 goal is 90%.

Well infant check-ups are evaluated by different methods. The Minnesota 2004 goal of 80% for children with Minnesota Medicaid health insurance was attained for infants, but not for older children. Rates from the Minnesota Department of Human Services (DHS) report include:

  • 60% for children of all ages;
  • 85% for infants under 1 year of age; and
  • 71% for children ages 1-2 years [3].

Data from billing reports is significantly different than those from C&TC claims submitted [4]. HMO data for well-child visits provided to infants between the ages of birth to 15 months show further areas for improvement.

  • Prepaid Medical Assistance Program (PMAP) rates for well-child visits for infants ranged between 20% to 50% depending on HMO [5].
  • Rates for MinnesotaCare well child visits for infants were about 45% depending on the HMO [5].
  • Well baby visit rates for children under the age of two were met 49.8% of the time using American Academy of Pediatrics (AAP) guidelines, 59.2% of the time using the C&TC guidelines and 69.6% of the time using the ICSI guidelines [4].

The quality of the well baby care provided is also important to track in addition to the frequency of visit according to national study [6].

Childhood Immunization, Minnesota 2001
  Percentage
2010 National Goal
90%
Minnesota (RKS 2001-2002)
81%

Minnesota is making progress towards meeting the national 2010 goals for childhood immunization. Several data sources track infant/childhood immunization levels by county including Minnesota Department of Health and Minnesota Department of Human Services data.

Areas of the state are significantly below the 81% immunization level of children up-to-date at 24 months of age. These areas include:

  • Greater Minnesota counties of Fillmore (63% UTD) and Pine (67% UTD); and
  • Urban cities of Minneapolis (66% UTD) and St. Paul (69% UTD) [2].

Similarly, geographic portions of Minnesota were more challenged in meeting the well child check-up standards for children on Medicaid:

  • Children living in the Twin Cities metropolitan area (82.7%) were more likely to meet the well child visit guidelines than children living in greater Minnesota (73.7%) [4].
  • Some rural counties, such as Roseau and Traverse (around 43%) are well below the state averages according to DHS data on C&TC [3].

Disparities
Parents report that non-white children (86.6%), with the exception of Asian children, were more likely than white children (76.9%) to meet the well child visit guidelines at all ages [2].

Nationally, race-specific immunization rates are increasing to meet the national goal, with the exception of immunization rates for African American children that have marginally increased since 1995 [7].

Economic
The CDC has documented that for every dollar spent on MMR vaccinations, $16.34 will be saved in health care costs and for every dollar spent on DPT shots, $6.21 will be saved (in 1992 dollars) [8]. Similarly, the benefits of well baby care are highlighted by The Commonwealth Fund [9].

Interventions

Recommendations for cost-effective interventions have been identified by the American Academy of Pediatrics and other national organizations which emphasize the need for well baby care and infant immunizations. A recent GAO report also supports efforts to ensure children’s access to health screening services [10].

Because immunizations and well baby screening are needed for all infants, regardless of health insurance coverage or health care provider, a community-wide intervention to improve the access and delivery of these critical services is needed [11].

Effectiveness of Interventions
Two studies looked at the effectiveness of well baby care. The studies highlight the importance of a series of well baby checks during the first two years of life as a preventive strategy for reducing avoidable hospitalizations and lowering medical costs [12,13].

Status

Minnesota Resources
Public health programs and strategies that promote well-baby care include:

  • Each Minnesota county and some tribes have a C&TC coordinator that provides timely information to eligible families/children about the health care benefits of the C&TC Program. They assist families to access C&TC services, make appointments, arrange for transportation and interpreters. They look for additional creative ways, beyond required activities, to provide effective outreach to the diverse populations within counties, community health boards and tribes.
  • Home visiting activities conducted by communities and public health agencies, have a goal of increasing infant immunization and well baby care by linking families to local health care providers.
  • The Cover All Kids Coalition, a public-private statewide effort, has a goal of connecting infants and children to health care providers for needed preventive services and attempting to locate health coverage for each child.

Community Awareness
No data is available on the level of community awareness for infant immunizations and well baby care. County and health insurance (public and commercial) data on actual utilization of these preventive services is available [14].

References

1. Minnesota Center for Health Statistics. 2003
2. MDH. Retrospective Kindergarten Survey Summary, 1992-2001.
3. Minnesota DHS.Medicaid Management Information System. Annual C&TC Participation Report, Federal Fiscal Year-2003. March 2004.
4. MDH. 2002 BRFSS Child Health Module Data Book. 2004.
5. MDH. Health Economics Program.The Minnesota HMO Profile-2000. February 2002.
6. 2000 National Survey of early Childhood Health. Pediatrics. 113. June 2003.
7. Child Trends DataBank, 2003. www.childtrendsdatabank.org
8. CDC. An Ounce of Prevention- What Are the Returns?. October 1999.
9. Leatherman S, McCarthy. Quality of Health Care for Children and Adolescents: A Chartbook. 2004. The Commonwealth Fund.
10. GAO. Stronger Efforts Needed to Ensure Children’s Access to Health Screening Services. Accessed 7-14-04 www.gao.gov/new.items/d01749.pdf [Attn: Non-MDH Link]
11. Margolis P, et al. From Concept to Application: The Impact of a Community Wide Intervention to Improve the Delivery of Preventive Services to Children. Pediatrics. September 2001. 108(3).
12. Hakim R, Bye B.Effectiveness of Compliance with Pediatric preventive Guidelines among Medicaid Beneficiaries. Pediatrics. 2001. 108:90
13. Keller. Study of Selected Outcomes of the Early and Periodic Screening, Diagnosis and Treatment Program in Michigan. Public Health Reports. 1983. 98:110.
14. Minnesota DHS, Minnesota HEDIS 2003 Medicaid Managed Care Results. December 2003.