Format

Send to

Choose Destination
Acad Pediatr. 2019 Apr 18. pii: S1876-2859(18)30717-4. doi: 10.1016/j.acap.2019.04.005. [Epub ahead of print]

Characteristics of High-Performing Primary Care Pediatric Practices: A Qualitative Study.

Author information

1
School of Public Health and Health Sciences (SL Goff and PS Pekow), University of Massachusetts-Amherst; Department of Medicine (SL Goff and PK Lindenauer); Institute for Health Care Delivery and Population Science (SL Goff, A Priya, PS Pekow, and PK Lindenauer), University of Massachusetts Medical School-Baystate, Springfield; Department of Quantitative Health Sciences (SL Goff and PK Lindenauer). Electronic address: sgoff@umass.edu.
2
Department of Medicine (KM Mazor); Meyers Primary Care Institute (KM Mazor), University of Massachusetts Medical School-Worcester.
3
Institute for Health Care Delivery and Population Science (SL Goff, A Priya, PS Pekow, and PK Lindenauer), University of Massachusetts Medical School-Baystate, Springfield.
4
School of Public Health and Health Sciences (SL Goff and PS Pekow), University of Massachusetts-Amherst; Institute for Health Care Delivery and Population Science (SL Goff, A Priya, PS Pekow, and PK Lindenauer), University of Massachusetts Medical School-Baystate, Springfield.
5
Department of Medicine (SL Goff and PK Lindenauer); Institute for Health Care Delivery and Population Science (SL Goff, A Priya, PS Pekow, and PK Lindenauer), University of Massachusetts Medical School-Baystate, Springfield; Department of Quantitative Health Sciences (SL Goff and PK Lindenauer).

Abstract

OBJECTIVE:

Performance on pediatric quality measures varies across primary care practices. Health care quality is associated with organizational factors, but their effect is understudied in pediatric care. This study aimed to develop hypotheses regarding the relationship between organizational factors and composite scores on pediatric quality measures.

METHODS:

Using a positive deviance approach, semistructured interviews were conducted with pediatricians and staff (N = 35) at 10 purposively selected high-performing pediatric primary care practices in Massachusetts between September and December 2016. Practices were sampled to achieve diversity in geographic location, size, and organizational structure. Interviews aimed to identify organizational strategies (eg, care processes) and contextual factors (eg, teamwork) that may be associated with performance on quality measures. Interviews were audiotaped, transcribed, and analyzed using qualitative content analytic methods.

RESULTS:

We identified 4 major themes (MTs): MT1, Practice Culture; MT2, Practice Structures and Quality Improvement Tools; MT3, Attitudes and Beliefs Related to Measuring Care Quality; and MT4, Perceived Barriers to Achieving High Performance on Quality Measures. MT1 subthemes included contextual factors such as teamwork, leadership, and feeling respected as an employee. MT2 subthemes included fixed characteristics such as practice size and strategies such as the use of an electronic medical record. MT3 and MT4 subthemes linked these constructs to factors external to the practices.

CONCLUSIONS:

This study suggested that elements of organizational culture may play as important a role in the quality of care delivered as specific quality improvement strategies. Interventions to further test this relationship may aid practices seeking to improve the care they deliver.

KEYWORDS:

organizational studies; pediatric health care quality; positive deviance; qualitative

PMID:
31004815
DOI:
10.1016/j.acap.2019.04.005

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center