The Quality of Ambulatory Care Delivered to Children in the United States

Mangione-Smith, Rita; DeCristofaro, Alison H.; Setodji, Claude Messan; Keesey, Joan; Klein, David J.; Adams, John; Schuster, Mark A.; McGlynn, Elizabeth A.

doi:10.1056/nejmsa064637

Cited by 530 publications

(338 citation statements)

References 29 publications

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“…The first two criteria have been used previously to assess validity and feasibility (27,28), the third and fourth criteria were formulated during Phase 2 with the expert panelists to assess relevance and likelihood of use. All criteria were Likerttype 1-9 scales with labeled end points.…”

Section: Phase 2: Expert Consensus Meeting To Finalize Scope Wordingmentioning

confidence: 99%

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

Barber¹,

Marshall²,

Alvarez³

et al. 2015

J Rheumatol

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Objective-Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QIs) for screening and use in Rheumatology clinics.Methods-A systematic review of the literature on CVD risk reduction in RA and the general population was conducted. Based on the best practices identified from this review, a draft set of 12 candidate QIs were presented to a Canadian panel of rheumatologists and cardiologists (n=6) from three academic centers to achieve consensus on the QI specifications. The resulting 11 QIs were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity and feasibility in three rounds of online voting and threaded discussion using a modified RAND/UCLA Appropriateness Methodology.Results-Response rates for the online panel were 86%. All 11 QIs were rated as highly relevant, valid and feasible (median rating ≥7 on a 1-9 scale) with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA, CV risk assessment, defining smoking status and providing cessation counseling, screening and addressing hypertension, dyslipidemia and diabetes, exercise recommendations, body mass index screening and lifestyle counseling, minimizing corticosteroid use and communicating to patients at high risk of CVD about the risks/benefits of non-steroidal antiinflammatory drugs. Conclusion-ElevenQIs for CVD care in RA patients have been developed and are rated as highly relevant, valid and feasible by an international multidisciplinary panel.

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Section: Phase 2: Expert Consensus Meeting To Finalize Scope Wordingmentioning

confidence: 99%

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

Barber¹,

Marshall²,

Alvarez³

et al. 2015

J Rheumatol

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“…[1][2][3][4] Challenges in delivering high quality care are particularly significant for providers caring for children who face increased risks for health care problems, including publicly insured children. [2][3][4] Quality measurement and reporting at the physician level is a common, potentially effective approach to improve the quality of health care, 5,6 and physician recertification programs have included a requirement for involvement in measuring the quality of care and quality improvement activities.…”

Section: Introductionmentioning

confidence: 99%

Primary Care Physicians' Experiences With and Attitudes Toward Pediatric Quality Reporting

Zickafoose

Ireys

Swinburn

et al. 2016

Academic Pediatrics

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Objectives-To assess primary care providers' experiences with and attitudes toward pediatricfocused quality reports and identify key associated physician/practice characteristics.Methods-We performed a cross-sectional survey of pediatricians and family physicians providing primary care to publicly insured children in three states (North Carolina, Ohio, Pennsylvania). The survey included questions about receipt of pediatric quality reports, use of reports for quality improvement (QI), and beliefs about the effectiveness of reports for QI. We used multivariable analyses to assess associations between responses and physician/practice characteristics, including exposure to federally funded demonstration projects aimed at increasing quality reporting to physicians serving publicly insured children. We supplemented these analyses with a thematic investigation of data from 46 interviews with physicians, practice staff, and state demonstration staff.Results-727 physicians responded to the survey (overall response rate: 45.2%). The majority of physicians were receiving quality reports related to pediatric care (79.8%, 95% confidence interval [CI] 77.2-82.4%) and believed that quality reports can be effective in helping guide quality improvement (70.5%, 95% CI 67.5-73.5%). Fewer used quality reports to guide QI efforts (32.5%, 95% CI 29.5-35.6%). There were no significant associations between demonstration exposure and experiences or attitudes. Interview data suggested physicians were receptive to quality reporting, but significant barriers remain to using such reports for QI, such as limited staff time or training in QI.Conclusion-While pediatric quality reporting is considered a promising strategy, in this study state efforts appeared insufficient to overcome the barriers to using reports to guide practice-based QI.

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“…Shortcomings include deficits in the receipt of recommended care for preventive services, acute care services, and chronic care services 1 ; fragmentation of care for children who see multiple health care providers 2 ; and lack of continuity in the primary care clinicians whom children see during early childhood. 3 Evidence also indicates that children with public insurance fare worse than privately insured children on many aspects of quality.…”

Section: Introductionmentioning

confidence: 99%

Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP

Devers

Foster

Brach

2013

Academic Pediatrics

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We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012-2 years into the 5-year demonstration projects-and analyzed states' grant applications, operating plans, and progress reports. The collaboratives have multiple complex aims. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. The duration of the collaboratives is longer than other well-known collaborative models. Collaboratives also vary in their methods for targeting areas for improvement and strategies for motivating practice recruitment and engagement. States also vary with respect to the other strategies they use to support QI and PCMH development. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used work-force augmentation (ie, providing care coordinators and QI specialists). Practice staff highly valued aspects of the collaboratives and supplemental strategies, including the opportunity to work with experts and other child-serving practices; states' efforts to provide stipends and align demonstration efforts with other professional requirements or programs; receipt of relevant, customized QI materials; opportunities to learn how care coordinators or QI specialists might work in their practice without the risk of hiring them; and satisfaction from learning more about quality measures, QI concepts and techniques, critical medical home components, and how to identify PCMH capacity and performance gaps. However, practice staff also reported a variety of challenges, including difficulty learning from other practices that have very different preexisting QI and PCMH capacity and patient populations, or that are working on different topic areas and measures; a sometimes overwhelming amount of materials and ideas covered during in-person meetings; difficulty keeping up with Webinars, calls, and Web sites/blogs; and trouble motivating and sharing information with other practice staff not attending collaborative activities. As the Address correspondence to Kelly J. Devers, PhD, 2100 M St NW, Washington, DC 20037, kdevers@urban.org. The views expressed in this report are those of the authors and do not necessarily represent those of the US Department of Health and Human Services, the Agency for Healthcare Research and Quality or the American Board of Pediatrics Foundation.The authors declare that they have no conflict of interest. HHS Public Access Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript demonstration p...

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The Quality of Ambulatory Care Delivered to Children in the United States

Abstract: Deficits in the quality of care provided to children appear to be similar in magnitude to those previously reported for adults. Strategies to reduce these apparent deficits are needed.

Cited by 530 publications

References 29 publications

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

Primary Care Physicians' Experiences With and Attitudes Toward Pediatric Quality Reporting

Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP

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