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Patient and provider factors associated with selected measures of quality of care
Insights
Continuity of pediatric care improves patient follow-up for chronic conditions. Comprehensive primary care settings enhance provider-initiated follow-up and patient compliance, crucial for quality pediatric services.
Area of Science:
- Pediatric Healthcare Quality
- Health Services Research
- Continuity of Care
Background:
- Assessing pediatric care quality is challenging due to undefined criteria, diverse patient needs, and disentangling patient vs. provider influences.
- Existing quality measures often lack specificity for the complexities of general pediatric care.
Purpose of the Study:
- To evaluate quality of pediatric care across different settings.
- To assess factors influencing follow-up care for pediatric patients.
- To examine the relationship between care setting and patient compliance.
Main Methods:
- Utilized data from a comprehensive pediatric service utilization study across five sites (neighborhood health centers, emergency room, hospital-based primary care).
- Selected quality measures included immunization status, screening procedures, and ongoing care for ten tracer conditions.
- Assessed follow-up adequacy by examining appointment scheduling (provider factor) and patient keeping appointments (patient factor).
Main Results:
- Immunization rates decreased with age.
- Follow-up appointment scheduling (provider factor) varied by healthcare site.
- Patient compliance (patient factor) was linked to both the site and the patient's pattern of service use.
- Follow-up care was more successful in primary care settings compared to emergency rooms, especially for patients with strong ties to primary care.
Conclusions:
- Continuity of care in comprehensive pediatric settings is associated with better follow-up and compliance.
- Primary care facilities demonstrate superior performance in managing ongoing pediatric care compared to emergency settings.
- Findings underscore the importance of integrated, continuous care models for improving pediatric health outcomes.
Abstract:
Studies assessing quality of general pediatric care are handicapped by (1) lack of explicit criteria, (2) the broad spectrum of medical needs presented, and (3) the need to distinguish between influence of patient and provider factors. In this study, part of a comprehensive study of utilization of pediatric services at five sites (three neighborhood health centers, an emergency room, and a hospital-based primary care program), we selected three measures sampling different aspects of quality of care, including (1) immunization status, (2) screening procedures, and (3) ongoing care for ten tracer conditons. Adequacy of follow-up of the tracer conditions was assessed along two dimensions: (1) whether a return appointment was scheduled, and (2) whether the patient kept the appointment ("compliance"). Results indicate that attainment of fully immunized status varies inversely with age, while for the tracer conditions, arrangement of follow-up (provider factor) was associated with site, and compliance (patient factor) was associated with both site and pattern of use. Accomplishment of follow-up was better for patients diagnosed in a primary care facility than in the emergency room and for patients with close ties to a primary care facility than for those with limited or no involvement with primary care. These findings support the value of continuity of care in a setting designed to deliver comprehensive care.