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Practice variation in parental assessment of pediatric ambulatory care
John Patrick T Co1, Ellie Macdonald, Recai M Yucel
1MGH Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA 02114, USA. jco@partners.org
Insights
Parental experiences in pediatric primary care varied significantly across practices, particularly in care coordination and specialty services. These findings highlight opportunities for quality improvement by sharing best practices among physicians.
Area of Science:
- Pediatric Primary Care
- Healthcare Quality Improvement
- Patient Experience Measurement
Background:
- Assessing parental experiences is crucial for evaluating pediatric primary care quality.
- Understanding practice-level variation is key to targeted quality improvement initiatives.
Purpose of the Study:
- To evaluate parental satisfaction with pediatric primary care physician practices.
- To identify variations in care quality across different practices.
Main Methods:
- A cross-sectional survey of 744 parents of children aged 12 years or younger.
- Parents rated practice performance across six quality domains: access, education, physician relationship, care coordination, staff, and specialty care.
Main Results:
- Practices excelled in patient education and access to care.
- Poorest performance was noted in care coordination/continuity and specialty care experience.
- Significant inter-practice variation was observed in specialty care, coordination, and access.
Conclusions:
- Parental feedback highlights areas for improvement in care coordination, specialty care, and interpersonal interactions.
- Performance differences among practices offer opportunities for inter-practice learning.
- Survey data effectively identifies quality variations and improvement priorities.
Objective:
To assess parental experience of pediatric primary care at the level of physician practice and to determine what variation exists among practices.
Methods:
This cross-sectional survey assessed 7 pediatric primary care practices in eastern Massachusetts. Parents of children aged < or =12 years who received care between July 1999 and June 2000 were surveyed. Parents assessed practice performance in 6 areas of quality: access to care, patient education and information, patient/physician relationship, coordination and continuity of care, office staff courtesy and helpfulness, and specialty care experience.
Results:
Surveys were returned by 744 parents (response rate 50%). Practices performed best in the domains of patient education and access to care, and performed poorest in coordination/continuity and specialty care experience. Practice performance varied in the included domains, with significant interpractice variation in specialty care experience (range 61-83 on 100-point scale), coordination and continuity (range 64-84), and access to care (range 80-92). Items with significant variation included the physician/nurse being informed about specialist care, the physician/nurse knowing the parent/child as people, staff helpfulness, and the physician/nurse knowing what worried the parent about the child's health.
Conclusions:
Parent reports of specific experiences of care revealed priorities for improvement in several areas, including coordination and continuity, specialty care experience, and interpersonal aspects of care. Performance differed among practices, providing an opportunity for practices to learn from each other. Survey-based measures of quality can help identify variation in performance and priorities for improving quality of care.
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