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Service quality and attrition: an examination of a pediatric obesity program
Max P Cote1, Terri Byczkowski, Uma Kotagal
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. max.cote@chmcc.org
Insights
Pediatric obesity program attrition is linked to insurance status and perceived quality of care, not demographics. Improving insurance support and engagement can help families return to treatment.
Area of Science:
- Pediatric Health
- Obesity Treatment
- Healthcare Management
Background:
- Pediatric obesity is a significant public health concern requiring effective, sustained treatment.
- Service attrition in pediatric obesity programs can hinder long-term patient outcomes.
- Understanding factors influencing program completion is crucial for optimizing care.
Purpose of the Study:
- To identify demographic, illness, and quality of care factors associated with service attrition in a pediatric obesity program.
- To explore reasons for premature discontinuation of treatment.
- To determine strategies that may encourage families to return to care.
Main Methods:
- A cross-sectional survey and semi-structured interviews were conducted with caregivers of patients in a pediatric obesity program.
- 120 families (74% participation rate) of 163 consecutively enrolled patients provided data.
- Service attrition was defined as discontinuing treatment before completing phase I.
Main Results:
- Service attrition was significantly associated with government-subsidized insurance status and perceived quality of care.
- Caregivers cited inadequate insurance coverage, child's desire to leave, and time commitment as primary reasons for attrition.
- Suggestions for improving retention included insurance assistance, proactive follow-up, and enhanced child engagement.
Conclusions:
- Demographic factors showed minimal association with service attrition in this pediatric obesity program.
- Perceived quality of care, even when rated highly overall, was a key factor in attrition.
- Few patients who discontinued services indicated they would not return, suggesting potential for recovery with targeted interventions.
Objective:
To examine the demographic, illness, and quality of care determinants of service attrition in a pediatric obesity program, and to elucidate factors that may promote families' return to care.
Design:
Cross-sectional survey with semi-structured interviews.
Setting:
A regional children's hospital in the United States.
Study Participants:
Caregivers of 163 patients, consecutively enrolled in a pediatric obesity treatment program between January 1998 and September 2000, were contacted by telephone and offered participation in a survey of clinical care experiences. A total of 120 (74%) families participated.
Main Outcome Measures:
Service attrition as defined as premature discontinuation of treatment before completing phase I of a multi-phase treatment program.
Results:
Multivariate results indicated that service attrition was associated with both insurance status and perceived quality of care. Patients with government-subsidized insurance were more likely to defect from services than those with commercial insurance. Perceived quality of care was highly associated with attrition after controlling for demographic and health parameters. Caregiver-reported reasons for service attrition included difficulty with adequate insurance coverage (53%), the child's desire to leave the program (50%), and the program taking too much time (32%). The most frequent suggestions to facilitate families' return to the program were: (i) assistance with insurance coverage; (ii) following up with families; and (iii) increasing engagement with the child.
Conclusions:
This study found few demographic differences between patients completing the program and those defecting from services. Both families completing the program and those discontinuing prematurely rated the overall quality of the program as high. However, lower quality of care was related to increased service attrition even after controlling for the effects of demographic and health parameters. Although a considerable number of patients discontinued services, very few reported that they would not return to the program. The results provide further support for ongoing audit and examination of families' care perceptions in preventing attrition and promoting service recovery.
