Identifying Factors Associated With High Quality Pediatric Primary Care

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 DESCRIPTION (provided by applicant): I am a general pediatrician and internist at Baystate Medical Center and an Assistant Professor of Medicine at the Tufts University School of Medicine in Boston, MA. Since completing a fellowship with the Robert Wood Johnson Clinical Scholars Program at Yale (2005) I have focused my career on improving maternal-child health care quality, with a particular emphasis on vulnerable populations. During my recent two-year KL-2 Career Development Award, I studied variation in risk-adjusted maternal infection rates in a national sample of hospitals and found substantial variation in infection rates. This discrepancy in care quality revealed a potential opportunity to improve rates in lower performing hospitals. During the first year of my KL-2, I received R21 funding from the Agency for Healthcare Research and Quality (AHRQ) to develop an intervention to improve access to publicly reported pediatric quality data for low income pregnant women. In this randomized controlled trial, we are determining whether an intervention to help these women use the publicly reported quality data impacts their choice of pediatrician. Both of these research experiences have been instrumental in my decision to pursue additional training in the field of dissemination and implementation research. This training will enable me to not only identify best practices for delivering high quality care to women and children, but also to test interventions to disseminate and implement these practices. My short- term career goals are to satisfy the criteria for a PhD in health policy and management while completing my proposed research study. My PhD will be focused on developing dissemination and implementation science skills, including further expertise in mixed-methods research. The training and education provided by this career development award will enable me to achieve my long-term goal of becoming an independent investigator in the field of maternal-child health care quality. As a core faculty member in Baystate Medical Center's (BMC) Center for Quality of Care Research (CQCR), I am in a strongly supportive research environment. Dr. Lindenauer, my primary mentor and the Director of the CQCR, is an accomplished dissemination and implementation scientist. He currently leads an NHLBI-funded study (1 R18 HL108810-01) that uses the positive deviance approach to identify best practices for implementing non-invasive ventilation for patients with respiratory failure. In addition, he leads an AHRQ- funded study (1 R18 HS 18645-01) in which he is conducting a national survey to understand the determinants of effective implementation of evidence based practices within a quality improvement collaborative. He is currently the primary mentor for three physician investigators supported by NIH Career Development Awards, and has mentored four KL-2/KM-1 awardees within the past three years. Prior mentees have successfully transitioned to independence with R01 level funding. The CQCR offers bio statistical and research assistant support to core faculty members and serves as an intellectual and scientific hub for health services researchers throughout BMC. The CQCR is also closely linked to Tufts Clinical and Translational Science Institute where I completed coursework for my KL-2, and where Dr. Lindenauer serves as a faculty member. Finally, as a PhD candidate in the School of Public Health and Health Sciences at the University of Massachusetts - Amherst, I will have access to high-level instruction and academic guidance in the multi- disciplinary fields critical to understanding and conducting dissemination and implementation research. There is a critical need to ensure that the nearly 75 million children in the U.S. receive the highest quality of health care possible. However, more than half of children in the U.S. do not receive recommended primary care and children from vulnerable populations are most affected. Although initiatives are underway nationwide to improve care quality for children, the field will benefit from scientists trained in dissemination and implementation science to translate quality of care research findings into practice. For my career development award project, I will perform a positive deviance study to identify the organizational strategies and contextual factors associated with high performance on pediatric primary care quality measures. This study will also serve as my PhD thesis project. The specific aims of the proposed study are: 1) to qualitatively identify organizational strategies and contextual factors common to primary care pediatric practices with high clinical quality and patient experience scores in Massachusetts; 2) to develop and test a questionnaire to determine which of the organizational strategies and contextual factors identified in Aim 1 are present in pediatric primary care practices; and 3) to determine the association between these strategies and factors and practice performance on clinical quality measures in pediatric offices throughout Massachusetts. This proposed study will build on our unique partnership with Massachusetts Health Quality Partners. This study's goals are highly responsive to the recent NIH-wide emphasis on using dissemination and implementation science to close the substantial gap between what is known to improve health care and actual care provided. They are also consistent with the mission of the National Institute of Child Health and Development "...to ensure that every person is born healthy... and that all children have the chance to achieve their full potential for healthy and productive lives, free from disease or disability".