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Primary care pediatricians identify barriers to recommended care
With the establishment of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program (PQMP), there is increased attention to the measurement and delivery of recommended care. Methods: A survey was sent to New Jersey pediatricians through the New Jersey Chapter, American Academy of Pediatrics database (n=3400). The survey elicited quantitative and qualitative data on barriers to the delivery of recommended care, related quality improvement (QI) initiatives, and opinions on QI processes. Results: 142 clinicians completed the on-line survey. 80% reported inadequate time during an office visit, 81% reported inadequate payment for delivery of recommended care. 86% reported that measurement of recommended care processes might not reflect quality of care provided. Respondents identified family issues as barriers, including resistance (87%), communication (75%), resources (74%), and concerns at the time of a visit (82%). Respondents did not believe that QI initiatives, such as participation in “Pay for Performance” or Accountable Care Organizations would improve quality of care (49%, 47%), or they were not familiar enough to determine their impact (23%, 36%). Conclusions: Primary care pediatricians identify time, payment issues, and family issues to be significant barriers to delivery of recommended care. Enhancements in QI processes, such as the design of electronic medical records, may improve the documentation of care, but may not alleviate the obstacles pediatricians identified in the delivery of recommended care. QI strategies for delivery of recommended care should consider pediatricians’ perspectives and the possible role public health initiatives.
Learning Areas:
Clinical medicine applied in public healthOther professions or practice related to public health
Provision of health care to the public
Learning Objectives:
Identify barriers to recommended care in primary care pediatrics
Qualified on the content I am responsible for because: I practiced primary care pediatrics for more than 18 years. I completed a Master of Public Health at the University of Pennsylvania in May, 2013. I currently am employed by the New Jersey Chapter, American Academy of Pediatrics. My work includes programs, funded by grants, to improve the quality of care delivered to children, specifically in the area of immunization.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.