Patient and Provider Factors Associated with Selected Measures of Quality of Care

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Abstract
Studies assessing quality of general pediatric care are handicapped by lack of explicit criteria, the broad spectrum of medical needs presented and the need to distinguish between influence of patient and provider factors. In part of a comprehensive study of utilization of pediatric services at 5 sites (3 neighborhood health centers, an emergency room and a hospital-based primary care program), 3 measures were selected for sampling different aspects of quality of care, including immunization status, screening procedures and ongoing care for 10 tracer conditions. Adequacy of follow-up of the tracer conditions was assessed along 2 dimensions: whether a return appointment was scheduled and whether the patient kept the appointment (compliance). Attainment of fully immunized status varied inversely with age, while for the tracer conditions, arrangement of follow-up (provider factor) was associated with site; compliance (patient factor) was associated with both site and pattern of use. Accomplishment of follow-up was better for patients diagnosed in a primary care facility than in the emergency room and for patients with close ties to a primary care facility than for those with limited or no involvement with primary care. These findings support the value of continuity of care in a setting designed to deliver comprehensive care.

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