Continuity of Care Is Associated With High-Quality Careby Parental Report

Christakis, Dimitri A.; Wright, Jeffrey A.; Zimmerman, Frederick J.; Bassett, Alta L.; Connell, Frederick A.

doi:10.1542/peds.109.4.e54

Cited by 73 publications

(46 citation statements)

References 21 publications

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“…First, the shift toward the USC for all or most care may reduce fragmentation of services and provide increased opportunities for primary care providers to establish and maintain relationships with children and families over time, potentially contributing to improved measures of quality over longer periods of observation. 104 Second, the relatively smaller scale of improvement among Hispanic children raises questions about the nature of these disparities and alternative strategies to combat them. Additional work beyond the provision of health insurance should strive to understand better the causes of continued disparity and should test creative strategies that are designed to address and eliminate disparities for Hispanic children.…”

Section: Discussionmentioning

confidence: 99%

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Shone¹,

et al. 2005

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ABSTRACT. Background. Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll.Objectives. The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors.Methods. Pre/post-parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP.Results. Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured >12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/ most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period.Conclusions. Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care. R acial/ethnic disparities in health care delivery are associated with adverse hea...

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Section: Discussionmentioning

confidence: 99%

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Shone¹,

et al. 2005

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“…Overall utilization of outpatient services increased only slightly, although the pattern of care changed markedly, with more visits to the USC. With mounting evidence for the importance of coordination and continuity of primary care, [84][85][86][87][88] it is reassuring that the provision of health insurance to low-income children may enhance this desirable pattern of service use. It is notable also that these improvements occurred even among children who had been insured through other systems, both private and public.…”

Section: Implications For Clinicians and Policy Makersmentioning

confidence: 99%

Improved Access and Quality of Care After Enrollment in the New York State Children's Health Insurance Program (SCHIP)

et al. 2004

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ABSTRACT. Background. Although many studies have noted that uninsured children have poorer access and quality of health care than do insured children, few studies have been able to demonstrate the direct benefits of providing health insurance to previously uninsured children. The State Children's Health Insurance Program (SCHIP), enacted as Title XXI of the Social Security Act, was intended to improve insurance coverage and access to health care for low-income, uninsured children. With limited state and federal resources for health care, continued funding of SCHIP requires demonstration of success of the program. As yet, little is known about the effectiveness of SCHIP on improving access and quality of care to enrollees.Objectives. To measure the impact of the New York State (NYS) SCHIP on access, utilization, and quality of health services for enrolled children.Design Setting. NYS, stratified into 4 regions. The NYS SCHIP is modeled on commercial insurance (32 managed care plans) and at the time of the study had 18% of SCHIP enrollees nationwide.Study Design. For the study group, the design used pre/poststudy telephone interviews of parents of children enrolling in the NYS SCHIP, with baseline interviews soon after enrollment and follow-up interviews 1 year after enrollment. Baseline interviews reflected the child's experience during the 1-year period before enrollment in SCHIP. The follow-up interviews reflected the 1-year period after enrollment in SCHIP. For the comparison group, the design used baseline interviews of a comparison group enrolled 1 year after the study group to test for secular trends; these interviews reflected the 1-year period before enrollment in SCHIP.Subjects. Children (n ‫؍‬ 2644) 0 to 18 years of age who enrolled in the NYS SCHIP for the first time (November 2000 to March 2001), stratified by age (0-5, 6-11, and 12-18 years), race/ethnicity (white non-Hispanic, black nonHispanic, and Hispanic; others excluded), and region of NYS. The comparison group consisted of 400 children. Telephone interviews were conducted in English or Spanish throughout the day and evening, 7 days per week, to obtain measures.Main Outcome Measures. Demographic and health measures (child and family characteristics, health status, presence of a special health care need, and prior health insurance), access (usual source of care [USC] and unmet needs for health care), utilization (visits for specific health services), and quality (continuity with USC and measures of primary care interactions). Analyses included bivariate tests, comparing the pre-SCHIP period to the 1-year period after enrollment in SCHIP. Multivariate models were computed to generate standardized populations comprised of key characteristics of the sample to test for differences in measures (after SCHIP versus before SCHIP), controlling for demographic characteristics.Results. Of the 2644 study-group children who completed the initial interview, 2290 (87%) completed the follow-up interview. Key measures for the pre-SCHIP period and short-term "pos...

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“…Our findings that access and continuity were associated with better parent-reported use of preventive medications is in accordance with other studies suggesting that continuity of care is linked with desirable outcomes. [33][34][35][36][37] Other practice-site policies that were associated with quality measures in preliminary multivariate models included case management, support for selfmanagement, and the use of written asthma management plans. These variables were not statistically significant in final models, but this in part might have been because these policies were highly correlated with other policies that accounted for more of the variation in quality.…”

Section: E108mentioning

confidence: 99%

Cultural Competence Policies and Other Predictors of Asthma Care Quality for Medicaid-Insured Children

et al. 2004

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ABSTRACT.Objective. More than half of Medicaid enrollees are now in managed care. Scant information exists about which policies of practice sites improve quality of care in managed Medicaid. Children with asthma are a sentinel group for Medicaid quality monitoring because they are at elevated risk for adverse outcomes. The objective of this study was to identify practice-site policies and features associated with quality of care for Medicaid-insured children with asthma.Methods. A prospective cohort study with 1-year follow-up was conducted in 5 health plans in California, Washington, and Massachusetts. Data were collected via telephone interviews with parents at baseline and 1 year, surveys of practice sites and clinicians, and computerized databases. The practice site survey asked about policies to promote cultural competence, the use of several types of reports to clinicians, support for self-management of asthma, case management and care coordination, and access to and continuity of care. Quality of care was evaluated on the basis of 5 measures: 1) preventive medication underuse based on parent report; 2) the parent's rating of asthma care; 3) the 1-year change in the child's asthma physical status based on a standardized measure; 4) preventive medication underprescribing based on computerized data; and 5) the occurrence of a hospitalbased episode.Results. Of the 1663 children in the study population, 67% had persistent asthma at baseline based on parent report of symptoms and medications. At 1-year followup, 65% of the children with persistent asthma were underusing preventive medication based on parent report. In multivariate analyses, patients of practice sites with the highest cultural competence scores were less likely to be underusing preventive asthma medications based on parent report at follow-up (odds ratio Poor and minority children are at elevated risk for asthma hospitalization, and many do not receive appropriate outpatient treatment. [1][2][3][4] In general, Medicaid-insured children may receive worse care than privately insured children, even when they are in the same health plans. 5 Scant information exists to help clinicians and policy makers understand how to improve health care quality effectively for children in managed Medicaid arrangements. 6 Clinicians who treat Medicaid-insured children need better information about which practice-site policies most enhance quality of care for this vulnerable group. Three general categories of practice-site policies are those that are tailored to low-income populations, chronic care policies, and primary care elements. Policies that are tailored to low-income populations attempt to promote cultural competence, 7-9 communication, and empowerment. Policies described in the Chronic Care Model include self-management support, decision support, clinical information systems, delivery system design, health care organization, and community resources. 10 Primary care elements have been defined as first-contact care (commonly called access), longitudinality (...

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Continuity of Care Is Associated With High-Quality Careby Parental Report

Cited by 73 publications

References 21 publications

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Improved Access and Quality of Care After Enrollment in the New York State Children's Health Insurance Program (SCHIP)

Cultural Competence Policies and Other Predictors of Asthma Care Quality for Medicaid-Insured Children

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