Identifying Factors Associated With High Quality Pediatric Primary Care

 描述（由申请人提供）：我是Baystate医疗中心的普通儿科医生和内科医生，也是马萨诸塞州波士顿塔夫茨大学医学院的医学助理教授。自从2005年完成耶鲁大学罗伯特·伍德约翰逊临床学者项目的奖学金以来，我的职业生涯一直专注于提高母婴保健质量，特别强调弱势群体。在我最近两年的KL-2职业发展奖期间，我研究了全国医院样本中风险调整后的孕产妇感染率的变化，发现感染率存在很大差异。这种护理质量的差异揭示了一个潜在的机会，以提高利率较低的医院。在我的KL-2的第一年，我收到了来自医疗保健研究和质量机构（AHRQ）的R21资金，以制定干预措施，改善低收入孕妇获得公开报告的儿科质量数据的机会。在这项随机对照试验中，我们正在确定帮助这些妇女使用公开报道的高质量数据的干预措施是否会影响她们对儿科医生的选择。这两个研究经验都有助于我决定在传播和实施研究领域进行额外的培训。这项培训将使我不仅能够确定为妇女和儿童提供高质量护理的最佳做法，而且还能测试干预措施， 推广和实施这些做法。我的短期职业目标是在完成我提议的研究学习的同时满足卫生政策和管理博士学位的标准。我的博士学位将专注于发展传播和实施科学技能，包括混合方法研究的进一步专业知识。这个职业发展奖提供的培训和教育将使我能够实现我的长期目标，成为母婴保健质量领域的独立调查员。 作为Baystate医学中心（BMC）护理质量研究中心（CQCR）的核心教员，我处于一个强有力的支持研究环境中。Lindenauer博士，我的主要导师和CQCR主任，是一位有成就的传播和实施科学家。他目前领导了一项由NHLBI资助的研究（1 R18 HL 108810 -01），该研究使用正偏差方法来确定对呼吸衰竭患者实施无创通气的最佳实践。此外，他还领导了一项AHRQ资助的研究（1 R18 HS 18645-01），在该研究中，他正在进行一项全国性调查，以了解在质量改进协作中有效实施循证实践的决定因素。他目前是NIH职业发展奖支持的三名医生研究人员的主要导师，并在过去三年中指导了四名KL-2/KM-1获奖者。以前的学员已经成功地过渡到独立与R 01级的资金。CQCR为核心教职员工提供生物统计和研究助理支持，并为整个BMC的卫生服务研究人员提供知识和科学中心。CQCR也与塔夫茨临床和转化科学研究所密切相关，我在那里完成了KL-2的课程，Lindenauer博士担任教职。最后，作为马萨诸塞州-阿默斯特大学公共卫生与健康科学学院的博士生，我将有机会获得对理解和开展传播和实施研究至关重要的多学科领域的高水平指导和学术指导。 目前迫切需要确保美国近7500万儿童获得尽可能高质量的医疗保健。然而，在美国，超过一半的儿童没有得到推荐的初级保健，来自弱势群体的儿童受到的影响最大。虽然全国范围内正在采取措施提高儿童护理质量，但该领域将受益于在传播和实施科学方面受过培训的科学家， 将护理质量研究成果付诸实践。对于我的职业发展奖项目，我将执行一个积极的偏差研究，以确定组织战略和相关因素与高性能的儿科初级保健质量的措施。这项研究也将作为我的博士论文项目。拟议研究的具体目的是：1）定性确定马萨诸塞州具有高临床质量和患者体验评分的初级保健儿科实践中常见的组织策略和背景因素; 2）开发和测试问卷，以确定目标1中确定的哪些组织策略和背景因素存在于儿科初级保健实践中;以及3）确定这些策略和因素与整个马萨诸塞州儿科诊所临床质量措施实践绩效之间的关联。这项拟议研究将建立在我们与马萨诸塞州健康质量合作伙伴的独特合作关系基础上。这项研究的目标是高度响应最近NIH范围内强调使用传播和实施科学，以缩小已知的改善医疗保健和实际提供的护理之间的巨大差距。它们也符合国家儿童健康和发展研究所的使命“.确保每个人出生时都是健康的所有儿童都有机会充分发挥其潜力，过上健康和富有成效的生活， 没有疾病或残疾”。

 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".