AAP Principles Concerning Retail-Based Clinics

Laughlin, James J.; Simon, Geoffrey R.; Barden, Graham A.; Brown, Oscar W.; Hardin, Amy Peykoff; Lessin, Herschel R.; Meade, Kelley; Moore, Scot; Rodgers, Chadwick T.

doi:10.1542/peds.2013-4080

Cited by 18 publications

(6 citation statements)

References 15 publications

(22 reference statements)

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“…Our study has potential clinical implications. In the past, some have raised concerns about the quality of care provided in walk-in clinics to the paediatric population 36. Although campaigns on antibiotic stewardship may be needed, our results and existing literature do not support this fear.…”

Section: Discussioncontrasting

confidence: 87%

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada

Marx,

Moore,

Talbot

et al. 2024

BMJ Open

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ObjectiveTo compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases.DesignA retrospective cohort study.SettingThis study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays.ParticipantsInclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma.Main outcome measuresThe primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients.ResultsWe included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)).ConclusionsThe incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.

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Section: Discussioncontrasting

confidence: 87%

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada

Marx,

Moore,

Talbot

et al. 2024

BMJ Open

View full text Add to dashboard Cite

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“…Responding to fears of fragmentation of care and potential loss of income, the American Academy of Pediatrics originally opposed and then opened the door to collaboration with these retail-based clinics, citing the benefit to families of improved access. 6 What the innovator's dilemma suggests is that, as these settings of care become increasingly successful, they are likely to leverage their strength to assume a broader share of care delivery, for example, by providing preventive services. The recent merger of CVS, a pharmacy and retail-based provider, and Aetna, a payor, exemplifies this pattern.…”

mentioning

confidence: 99%

“…For those prioritizing convenient and off-hours care, these sites offer advantages in terms of access and potentially expense, especially for low-acuity conditions. Responding to fears of fragmentation of care and potential loss of income, the American Academy of Pediatrics originally opposed and then opened the door to collaboration with these retail-based clinics, citing the benefit to families of improved access . What the innovator’s dilemma suggests is that, as these settings of care become increasingly successful, they are likely to leverage their strength to assume a broader share of care delivery, for example, by providing preventive services.…”

mentioning

confidence: 99%

Consumerism, Innovation, and the Future of Pediatric Primary Care

2018

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Netflix was founded in 1997 to allow consumers access to video content from home. By 2000, focused on second-tier films, Netflix developed a subscription service featuring unlimited, fixed-price rentals. That same year, Netflix approached Blockbuster, the dominant movie rental company at that time, first offering to become Blockbuster's online retail arm and then to sell itself for $50 million. Both offers were declined. In 2008, Blockbuster declared that Netflix is "not even on the radar screen in terms of competition." 1 Failing to recognize Netflix's ability to satisfy the customer, Blockbuster filed for bankruptcy in 2010. In contrast, Netflix, now with more than 100 million subscribers, achieved dominance by betting on emerging technology for streaming video. What might this example teach us about the future of a very different service, pediatric primary care? By many measures, pediatric primary care is thriving. Primary care pediatricians serve a growing proportion of children compared with other specialists, are more accessible to the underserved, and address increasingly complex health and social problems. In parallel, the concept of the medical home championed by the American Academy of Pediatrics has fostered health care that is comprehensive, patient centered, and technology enabled, and that engages community resources.However, the Blockbuster case suggests that impressive achievements and scale should not lull any business, even one addressing a compelling social good, into complacency. Financial and lifestyle demands have already triggered dramatic changes in US pediatric primary care, with almost two-thirds of pediatricians working in group or health maintenance organization practices, compared with fewer than half of all pediatricians in the late 1980s. Now, a new wave of pressures from disruptive, consumer-focused competitors are challenging practice models. In this Viewpoint, we argue that these pressures threaten to undermine the medical home and underscore the urgent need for pediatricians to rethink the delivery of primary care.These pressures embody 2 prominent business concepts that provide a framework for understanding and responding to market challenges: creative destruction and the "innovator's dilemma." 2,3 Creative destruction emphasizes that all businesses and industries proceed through stages of formation, growth, maturity, and decline. As industries approach the decline stage, they can either disappear, as Blockbuster did, or reinvent themselves. Creative destruction is driven by changes in technology and consumer priorities, 2 forces directly affecting primary care. The innovator's dilemma addresses a common way in which existing businesses succumb to innovators. These businesses, including

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“…6–8 In one study, 37% of pediatric providers reported suboptimal care for their patients seen in adult outpatient retail clinics. 9…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] In one study, 37% of pediatric providers reported suboptimal care for their patients seen in adult outpatient retail clinics. 9 Pediatric Quality and Safety Due to the number of unnecessary antibiotics prescribed in the outpatient setting and the AAP's concern regarding pediatric patients seeking care in retail clinics, we decided to develop a QI project focused on the accurate diagnosis and treatment of AOM in our hospital-owned pediatric retail clinic. The specific aim for this improvement project was to increase the percentage of compliant AOM diagnostic and treatment bundles from 42% to 95% for pediatric patients seen in an outpatient pediatric hospital-owned retail clinic by July 1, 2020.…”

Section: Introductionmentioning

confidence: 99%

QI Project Promoting NP Compliance with an AOM Bundle in Pediatric Hospital-owned Retail Clinic

Joo

Sandberg

Albertini

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: The most common diagnosis for pediatric antibiotic prescriptions is acute otitis media (AOM). Therefore, it is logical to focus on AOM when striving to improve antibiotic prescribing in pediatrics. This quality improvement project aimed to improve documentation of diagnostic criteria and physical examination findings in the medical record and improve adherence to recommended antibiotic prescribing recommendations for AOM by nurse practitioners at a children’s hospital-owned pediatric retail clinic. Methods: We used The Institute for Healthcare Improvement’s Quality Improvement methodology to introduce an AOM quality bundle to providers in a pediatric retail clinic. We created Plan-Do-Study-Act ramps and implemented interventions, including NP education, electronic medical record improvements, and parent engagement. The percentage of compliant bundles (all five specific predetermined criteria successfully met) was measured for all patients diagnosed with AOM. Results: Baseline AOM bundle compliance began at a mean of 42%. Pareto analysis of baseline data indicated that antibiotic choice and duration were key failure modes. Antibiotic choice or duration errors occurred in 48% of reviewed charts at project inception. The interventions introduced throughout the project led to steady improvement in the percent of compliant bundles. The goal of 95% compliant bundles was achieved and maintained. At the project’s conclusion, 98% of antibiotic prescriptions were accurate. Conclusions: Implementation of multiple interventions with increasing levels of reliability improved the overall quality of documentation and increased the appropriate antibiotic prescriptions provided for patients diagnosed with AOM and seen by nurse practitioners at the retail clinic.

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AAP Principles Concerning Retail-Based Clinics

Cited by 18 publications

References 15 publications

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada

Consumerism, Innovation, and the Future of Pediatric Primary Care

QI Project Promoting NP Compliance with an AOM Bundle in Pediatric Hospital-owned Retail Clinic

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