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Practice Variation in Parental Assessment of Pediatric Ambulatory Care

  • John Patrick T. Co
    Correspondence
    Address correspondence to John Patrick T. Co, MD, MPH, MGH Center for Child and Adolescent Health Policy, 50 Staniford Street, Suite 901, Boston, Massachusetts 02114.
    Affiliations
    MGH Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Dr Co and Dr Ferris); Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Ms McDonald and Dr Ferris); and Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Albany, NY (Dr Yucel)
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  • Ellie MacDonald
    Affiliations
    MGH Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Dr Co and Dr Ferris); Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Ms McDonald and Dr Ferris); and Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Albany, NY (Dr Yucel)
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  • Recai M. Yucel
    Affiliations
    MGH Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Dr Co and Dr Ferris); Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Ms McDonald and Dr Ferris); and Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Albany, NY (Dr Yucel)
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  • Timothy G. Ferris
    Affiliations
    MGH Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Dr Co and Dr Ferris); Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Ms McDonald and Dr Ferris); and Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Albany, NY (Dr Yucel)
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      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 ≤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.

      Key Words

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