Practice variation in parental assessment of pediatric ambulatory care

Do parent perceptions predict continuity of publicly funded care for attention-deficit/hyperactivity disorder?

OBJECTIVE

To examine whether parent perceptions about care (barriers, disorder knowledge, treatment willingness) vary among children who drop out of or stay in publicly funded care for attention-deficit/hyperactivity disorder (ADHD) and to explore whether parent perceptions are predictive of staying in care over time.

METHODS

A longitudinal cohort study of 529 children ages 5 to 11 years receiving care for ADHD in primary care or specialty mental health clinics in a large, countrywide, managed-care Medicaid program. Multiple logistic regression analyses were performed to identify parent perceptions associated with the likelihood of staying in care across three 6-month time intervals, controlling for child and parent demographic characteristics, parental distress, clinical need, and recent special education use.

RESULTS

At least three-fourths of children had at least 1 contact for any mental health care during a 6-month time interval (75%, 85%, 76%). Parent-perceived barriers, ADHD knowledge, and counseling willingness did not predict staying in care, whereas willingness for medication treatment was predictive at baseline. Minority status, nonmarried parent, parental distress, clinical need, and special education use were predictive of staying in care, but mostly during only one 6-month time interval, and their influence varied over time.

CONCLUSIONS

Parent willingness for medication treatment along with several demographic and need factors predicted staying in care but not consistently over time. Future research is needed to develop practical tools for clinicians to elicit parent priorities about ADHD treatment and to integrate them into quality-improvement interventions targeted to improving shared decision-making for longer term ADHD care.

Avaliação da associação entre qualificação de médicos e enfermeiros em atenção primária em saúde e qualidade da atenção

Este estudo objetivou verificar a associação entre os atributos da atenção primária à saúde (APS) e a qualificação profissional de médicos e enfermeiros. Utilizou-se o Instrumento de Avaliação da Atenção Primária, versão infantil (PCATool infantil), com aplicação aos cuidadores das crianças residentes e cadastradas nas áreas das equipes de saúde da família. Os atributos da APS foram avaliados através dos escores aferidos pelos cuidadores. Após análises bivariadas, a associação entre o grau de orientação para a APS e as características socioeconômicas e demográficas, bem como as características profissionais e das unidades de saúde foram verificadas através de ajuste multivariado pela Regressão de Poisson. As equipes onde atuavam profissionais com residência em saúde da família ou residência de medicina de família e comunidade apresentaram escores dos atributos da APS mais elevados do que os escores das equipes onde os profissionais não possuíam tal qualificação. Os autores concluíram que a especialização na modalidade residência de medicina de família e comunidade para médicos e residência em saúde da família enfermeiros apresenta potencialidades para a transformação do modelo de atenção, a partir dos atributos da APS.

Measuring patient and family experiences of health care for children

BACKGROUND

The Institute of Medicine considers patient centeredness a core dimension of quality. Several patient/family surveys exist to assess pediatric health care. The Children's Health Insurance Program Reauthorization Act mandates strengthening quality measurement for children, including for patient/family experience of care.

OBJECTIVES

The aim of this study was to determine what instruments exist for measuring patient/family experience of pediatric health care and which should be included in the core measurement set for assessing Medicaid and the Children's Health Insurance Program (CHIP) programs; to identify gaps in measurement; and to provide recommendations for measure development.

METHODS

We developed a conceptual framework for measuring patient/family experience of care. We conducted a review of national measure clearinghouses and of the literature to assess validity, reliability, and feasibility of existing measures, and how these measures address the conceptual framework.

RESULTS

We found valid and reliable instruments for measuring patient/family experience of care include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) instruments, Promoting Healthy Development Survey (PHDS), Young Adult Health Care Survey (YAHCS), and the National Research Corporation Picker Pediatric Inpatient Survey (NRC Picker). We identified the need for matching patients with providers and groups as a barrier for widespread use of the CAHPS® pediatric clinician & group instrument.

CONCLUSIONS

We recommended to the National Advisory Council for Healthcare Research and Quality Subcommittee on Children's Healthcare Quality Measures for Medicaid and Child Health Insurance Programs (SNAC) the CAHPS® Child Medicaid 4.0 and pediatric Clinician & Group Survey for inclusion in the initial recommended list of core measures for voluntary use by Medicaid and CHIP. The Clinician and Group Survey was not included in the list posted for public comment due to concerns at that time (December 2009) about feasibility. We also recommended that development of a child version of the CAHPS® behavioral and mental health survey now used in the adult population and of a pediatric hospital CAHPS® measure be considered high priorities for development in the next phase of Children's Health Insurance Program Reauthorization Act measurement activity. This phase should also explore methods to increase response rates and lower costs of obtaining consumer feedback.