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The better model to predict and improve pediatric health care quality: performance or importance-performance?
Rebecca M Olsen1, Carol A Bryant, Robert J McDermott
1Rebecca M. Olsen, PhD, is Associate Professor of Public Health, Health Science and Human Performance, College of Natural and Health Sciences, University of Tampa, Florida. E-mail: Rolsen@ut.edu. Carol A. Bryant, PhD, is Distinguished USF Health Professor in Community and Family Health, Co-Director, Florida Prevention Research Center, College of Public Health, University of South Florida, Tampa. Robert J. McDermott, PhD, is Professor of Health Education and Public Health, Co-Director, Florida Prevention Research Center, College of Public Health, University of South Florida, Tampa. David Ortinau, PhD, is Professor of Marketing, College of Business Administration, University of South Florida, Tampa.
Insights
The importance-performance model better predicts pediatric health care quality than performance-only models. Understanding attribute importance is key for effective quality improvement in pediatric healthcare.
Area of Science:
- Pediatric Health Services Research
- Health Care Quality Measurement
- Patient-Reported Outcomes
Background:
- Improving pediatric health care quality is a continuous goal, yet effective strategies are hindered by challenges in measuring quality from a parent's perspective.
- Lack of robust evaluation research limits the success of quality improvement initiatives in pediatric healthcare.
Purpose of the Study:
- To compare performance-only and importance-performance models for predicting pediatric health care quality.
- To identify the most effective method for improving the quality of care provided to children.
Main Methods:
- A cross-sectional study of 14 pediatric centers in West Central Florida, surveying 1,030 parents.
- Exploratory factor analysis identified five dimensions of care: physician care, access, customer service, timeliness, and facility.
- Hierarchical multiple regression compared performance-only and importance-performance models using 50 health care attributes.
Main Results:
- The importance-performance multiplicative additive model demonstrated superior predictive capability for pediatric health care quality.
- Attribute importance was found to moderate the relationship between performance and overall quality.
Conclusions:
- The importance-performance model offers a superior approach to measuring and understanding pediatric health care quality.
- Prioritizing improvements based on attribute importance, not just performance, is crucial for efficient resource allocation and effective quality enhancement in pediatric healthcare organizations.
Background:
The perpetual search for ways to improve pediatric health care quality has resulted in a multitude of assessments and strategies; however, there is little research evidence as to their conditions for maximum effectiveness. A major reason for the lack of evaluation research and successful quality improvement initiatives is the methodological challenge of measuring quality from the parent perspective.
Purpose:
Comparison of performance-only and importance-performance models was done to determine the better predictor of pediatric health care quality and more successful method for improving the quality of care provided to children.
Approach:
Fourteen pediatric health care centers serving approximately 250,000 patients in 70,000 households in three West Central Florida counties were studied. A cross-sectional design was used to determine the importance and performance of 50 pediatric health care attributes and four global assessments of pediatric health care quality. Exploratory factor analysis revealed five dimensions of care (physician care, access, customer service, timeliness of services, and health care facility). Hierarchical multiple regression compared the performance-only and the importance-performance models. In-depth interviews, participant observations, and a direct cognitive structural analysis identified 50 health care attributes included in a mailed survey to parents(n = 1,030). The tailored design method guided survey development and data collection.
Findings:
The importance-performance multiplicative additive model was a better predictor of pediatric health care quality.
Practice Implications:
Attribute importance moderates performance and quality, making the importance-performance model superior for measuring and providing a deeper understanding of pediatric health care quality and a better method for improving the quality of care provided to children. Regardless of attribute performance, if the level of attribute importance is not taken into consideration, health care organizations may spend valuable resources targeting the wrong areas for improvement. Consequently, this finding aids in health care quality research and policy decisions on organizational improvement strategies.
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