Does Quality of Primary Care Vary by Level of Training in Pediatric Resident Continuity Practices?

• Published in: Academic pediatrics 2009-07, Vol.9 (4), p.228-233
• Main Authors: Krugman, Scott D., MD, MS, Garfunkel, Lynn C., MD, Olsson, John M., MD, Ferrell, Cynthia L., MD, MSEd, Serwint, Janet R., MD
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Child; Child, Preschool; Clinical Competence; Confidence Intervals; continuity experience; Continuity of Patient Care - standards; Cross-Sectional Studies; Education, Medical, Graduate; Female; Humans; Infant; Internship and Residency - methods; Internship and Residency - standards; level of training; Neonatal and Perinatal Medicine; Odds Ratio; Parents; pediatric resident; Pediatrics; Pediatrics - education; Pediatrics - standards; Primary Health Care - methods; Primary Health Care - standards; Probability; quality of care; Quality of Health Care; United States
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2008.12.010

Objective The aim of this study was to compare parental perception of quality of care provided by first- versus third-year pediatric residents who served as their children's primary care providers. Methods The Parents' Perception of Primary Care (P3C) survey was administered to all parents who identified a pediatric resident as a primary care provider at 19 Continuity Research Network (CORNET) sites. Parent survey scores were compared between those identifying first-year pediatric residents (PL-1) versus third-year pediatric residents (PL-3) as care providers by using t tests and linear regression modeling, as well as item-specific chi-square analysis and logistic regression. Results Comparing the responses of the 347 parents who identified a PL-3 resident and the 360 parents who identified a PL-1 resident as their child's primary care provider, those who identified a PL-3 resident rated their childrens overall care higher, with a mean score of 79.2 (95% confidence interval [95% CI] 77.5–80.8) as compared to 75.9 (95% CI 74.4–77.3); P < .05. This disparity was primarily due to differences in the longitudinal continuity domain. Comparisons of the other domains of communication, comprehensiveness, access, contextual knowledge, and coordination showed no statistically significant differences between the 2 groups. Parents rated PL-3 residents as having greater knowledge in behavioral counseling and coordination with schools than PL-1 residents. Conclusions Parents rated residents at both training levels very highly for the quality of care provided. PL-3 residents had higher longitudinal continuity scores and were perceived to have greater knowledge about behavioral counseling and coordination of care with schools. Further research will need to elucidate strategies to improve earlier resident acquisition of coordination and behavior management skills.