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

ABSTRACT: To assess primary care providers' experiences with and attitudes toward pediatric-focused quality reports and identify key associated physician/practice characteristics.We performed a cross-sectional survey of pediatricians and family physicians providing primary care to publicly insured children in 3 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.Seven hundred twenty-seven physicians responded to the survey (overall response rate: 45.2%). Most 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 QI (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 that 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.Although 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.

SUBMITTER: Zickafoose JS

PROVIDER: S-EPMC5847285 | biostudies-literature | 2016 Nov - Dec

REPOSITORIES: biostudies-literature

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

Zickafoose Joseph S JS Ireys Henry T HT Swinburn Adam A Simpson Lisa A LA

Academic pediatrics 20160721 8

<h4>Objective</h4>To assess primary care providers' experiences with and attitudes toward pediatric-focused quality reports and identify key associated physician/practice characteristics.<h4>Methods</h4>We performed a cross-sectional survey of pediatricians and family physicians providing primary care to publicly insured children in 3 states (North Carolina, Ohio, Pennsylvania). The survey included questions about receipt of pediatric quality reports, use of reports for quality improvement (QI), ...[more]

PMID: 27452883

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Project description:BackgroundSince 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally.GoalsTo assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care.MethodThe study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians - 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans.Main findingsThe vast majority of respondents (87%) felt that the monitoring of quality was important and two-thirds (66%) felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71%) supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners). At the same time, support for the program was widespread even among physicians who are young, board-certified in family medicine, and salaried.Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%), over-competitiveness (60%), excessive managerial pressure (48%), and distraction from other clinical issues (35%). In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems.ConclusionsThe findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified.

Dataset Information

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

Publications

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

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