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The Use of Parent Report to Assess the Quality of Care in Primary Care Visits Among Children With Asthma

  • Yvonne D. Senturia
    Correspondence
    Address correspondence to Yvonne D. Senturia, MD, MSc, Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, 1300 Morris Pk, NR 7S12, Bronx, NY 10461
    Affiliations
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  • Laurie J. Bauman
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • Yvonne M. Coyle
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • Wayne Morgan
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • David L. Rosenstreich
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • Maryse D. Roudier
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • Herman Mitchell
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • Rebecca Gruchalla
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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  • Ellen F. Crain
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY (Dr Senturia and Dr Crain); Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY (Dr Bauman); Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Tex (Dr Coyle); The University of Arizona College of Medicine, Tucson, Ariz (Dr Morgan); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Rosenstreich); Data Coordinating Center, Boston University School of Public Health, Boston, Mass (Dr Roudier); Data Coordinating Center, Rho Inc, Chapel Hill, NC (Dr Mitchell); and University of Texas Southwestern Medical Center at Dallas, Tex (Dr Gruchalla).
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      Objective.—To determine the accuracy of parent report and the accuracy of the medical record in documenting physician performance of elements of pediatric asthma care in the primary care setting.
      Methods.—A convenience sample of 79 English-speaking parents of 4–12-year old children with asthma presenting to medical center–affiliated inner-city primary care pediatric clinics in the Bronx, Dallas, and Chicago was enrolled, and the office visit was audiotaped. Parents were interviewed 1–16 days after the visit by telephone.
      Outcome Measures.—Accuracy of parent report was the primary outcome. The “reference standard” was an independent evaluation of the audiotaped record of the primary care visit. The National Asthma Education and Prevention Program was used as a guide to select data elements to assess quality of pediatric asthma care during primary care visits.
      Results.—Sufficient documentation was significantly (P < .001) less likely to be present in the medical record than in the follow-up interview for each element of care. When these elements were combined into a cumulative score, 71% of parent interviews but only 37% of medical records scored ≥5 (out of a possible 6), with 29% of medical records scoring <3. Parents were able to accurately report (concordance of parent data with audiotape reference standard) whether or not the visit had included performance of 5 of the 6 elements of care.
      Conclusions.—Our study suggests that parent telephone interview within 2 weeks after the visit is more accurate than the medical record for documentation of the quality of asthma care in pediatric primary care visits. The medical record was not sufficient to assess the quality of primary care related to asthma, primarily because of missing data. Therefore, our data suggest that assessing quality of care using the medical record will not only bias the findings in the direction of more deficient care but will also make improvement in care more difficult. Further validation of our strategy for using parent report to assess the quality of care in primary care visits will require its application in a variety of other primary care settings.

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