Krugman Scott D, Racine Andrew, Dabrow Sharon, Sanguino Sandra, Meyer Walter, Seid Michael, Serwint Janet R
Department of Pediatrics, Franklin Square Hospital Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA.
Pediatrics. 2007 Aug;120(2):e262-71. doi: 10.1542/peds.2006-1346. Epub 2007 Jul 30.
Pediatric resident continuity practices provide care to more than one fifth of the socioeconomically disadvantaged population of the United States. With the structural challenges of resident training, there may be concerns about a lower quality of care received by patients. The objectives of this study were to measure parental perception of resident primary care, to determine the characteristics associated with better care, and to compare perception with a previously published community standard.
A cross-sectional survey using the Parents' Perception of Primary Care was conducted of patients enrolled at 19 national academically affiliated resident continuity practices from the Continuity Research Network. Outcome measures included mean total scale score for the Parents' Perception of Primary Care and mean scores for each primary care domain. Comparisons were made between the subset of resident patients who were older than 5 years and a previously published community survey of parents of school-age children.
A total of 2572 patients were enrolled with a final sample size of 2211 analyzable surveys. The sample was 37% black and 40% Hispanic; 81% of the children had Medicaid insurance; and 20% of the parents had less than a high school education. Parents rated the care that they received in resident continuity with high total scores and subscale scores, with an overall mean total scale score of 74.0. Higher scores were associated with number of visits to the provider and being able to name the resident as the primary care provider, whereas minority status was associated with lower access and communication scores. The resident sample over age 5 had higher mean scores for the total scale and every domain as compared with the community sample.
Parents of patients at resident continuity sites rated residents as providers of high-quality care to a socioeconomically disadvantaged population as compared with a previously published community sample. Efforts to improve resident continuity and identification may help improve care delivered in resident practices.
儿科住院医师连续性医疗服务为超过五分之一的美国社会经济弱势群体提供医疗服务。鉴于住院医师培训面临的结构性挑战，可能有人担心患者接受的医疗服务质量较低。本研究的目的是衡量家长对住院医师初级医疗服务的看法，确定与更好医疗服务相关的特征，并将这些看法与先前公布的社区标准进行比较。
使用《家长对初级医疗服务的看法》对来自连续性研究网络的19家全国性学术附属住院医师连续性医疗服务机构登记的患者进行横断面调查。结果指标包括《家长对初级医疗服务的看法》的平均总分以及每个初级医疗领域的平均得分。对年龄超过5岁的住院患者子集与先前公布的学龄儿童家长社区调查结果进行了比较。
共纳入2572名患者，最终样本量为2211份可分析调查。样本中37%为黑人，40%为西班牙裔；81%的儿童有医疗补助保险；20%的家长受教育程度低于高中。家长对他们在住院医师连续性医疗服务中接受的护理给予了较高的总分和子量表分数评价，总体平均总分74.0。较高的分数与就诊次数以及能够说出住院医师是初级医疗服务提供者有关，而少数族裔身份与较低的就医机会和沟通分数有关。与社区样本相比，5岁以上的住院患者样本在总分和每个领域的平均得分更高。
与先前公布的社区样本相比，住院医师连续性医疗服务机构患者的家长将住院医师评为为社会经济弱势群体提供高质量医疗服务的提供者。改善住院医师连续性和识别度的努力可能有助于提高住院医师医疗服务中的医疗质量。
