Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis
- 83 Downloads
Pediatric practices’ scores on healthcare quality measures are increasingly available to the public. However, patients from low-income and racial/ethnic minority populations rarely use these data. We sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice.
As part of a randomized trial to overcome barriers to using quality data, we recruited women from a prenatal clinic serving an underserved population. Women reported how much 12 factors mattered when they chose a pediatric practice (5-point Likert scale), what other factors mattered to them, and which factors mattered the most. We assessed whether factor importance varied with selected participant characteristics and qualitatively analyzed the “other” factors named.
Participants’ (n = 367) median age was 23 years, and they were largely Hispanic (60.4%), white (21.2%), or black (16.9%). Insurance acceptance “mattered a lot” to the highest percentage of women (93.2%), while online information about what other parents think of a practice “mattered a lot” to the fewest (7.4%). Major themes from our qualitative analysis of “other” factors that mattered included physicians’ interpersonal skills and pediatrician-specific traits. Factors related to access “mattered the most” to the majority of women.
Pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics. Aligning both the content and delivery of publicly reported quality data with women’s interests may increase use of pediatric quality data.
Clinical Trial Registration
KeywordsPediatric healthcare quality Choosing a pediatric practice Low income Minority Pregnant women
We would like to thank the staff at the Wesson Women’s Clinic for their gracious welcoming of our presence in their clinic during the course of this study and Massachusetts Health Quality Partners for their assistance with technical aspects of the data.
Compliance with Ethical Standards
This study was funded by the Agency for Healthcare Research and Quality (AHRQ) R21HS021864. AHRQ did not have any involvement in the study design, data collection, analysis, manuscript, or submission decisions. Dr. Goff is currently supported by the National Institute of Child Health and Human Development Award Number K23HD080870. Dr. Lagu is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health Award Number K01HL114745.
Conflicts of Interest
Dr. White is a consultant for Actavis.
- 1.NCQA > HEDIS & Quality Measurement [Internet]. [cited 2013 Oct 1];Available from: http://www.ncqa.org/HEDISQualityMeasurement.aspx
- 5.Ketelaar NABM, Faber MJ, Flottorp S, Rygh LH, Deane KHO, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev. 2011;11:CD004538.Google Scholar
- 14.Hill C, Garner S. Factors influencing physician choice. Hosp Health Serv Adm. 1990;36(4):491–503.Google Scholar
- 21.Turow JA, Sterling RC. The role and impact of gender and age on children’s preferences for pediatricians. Ambul Pediatr Off J Ambul Pediatr Assoc. 2004;4(4):340–3.Google Scholar
- 22.Goff SL, Mazor KM, Pekow, PS, et al. (2016) Patient navigators and parent use of quality data: A Randomized Trial. PediatricsGoogle Scholar
- 30.Patient Satisfaction Measurement: Current Issues and Implications : Professional Case Management [Internet]. LWW. [cited 2015 Feb 2];Available from: http://journals.lww.com/professionalcasemanagementjournal/Fulltext/2002/09000/Patient_Satisfaction_Measurement__Current_Issues.6.aspx
- 34.Lagu T, Goff SL, Hannon NS, Shatz A, Lindenauer PK. A mixed-methods analysis of patient reviews of hospital care in England: implications for public reporting of health care quality data in the United States. Jt Comm J Qual Patient Saf Jt Comm Resour. 2013;39(1):7–15.Google Scholar
- 35.Emmert M, Schlesinger M. Hospital quality reporting in the United States: does report card design and incorporation of patient narrative comments affect hospital choice? Health Serv Res 2016;Google Scholar
- 36.Physician Compare Initiative - Centers for Medicare & Medicaid Services [Internet]. [cited (2016) Feb 17];Available from: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/physician-compare-initiative/