Abstract

Several studies have reported deficits in quality of care delivered to children in the United States. However, there is limited research on quality of care provided to underrepresented populations and no research evaluating care delivered by pediatric residents in a continuity clinic. The objective of this study was to determine the percent of recommended care delivered to children with asthma in a predominantly underserved, Medicaid-dependent population by pediatric residents in a continuity clinic at Orlando Health and compare these results to a national quality of care report. Quality was assessed using 10 quality indicators previously developed, validated, and published based on national guidelines. For all children with a billing diagnosis of asthma seen at OH in 2008 and 2009, charts were reviewed to determine whether indicated care was delivered. Quality scores were determined by dividing the number of times indicated care was met by number of times indicator eligibility was met. Scores were compared with a national report using Fisher’s exact test. Charts were reviewed for 427 patients seen for 1903 clinic visits (60% male, 90% public insurance, average age 6.3 ± 4.4 years). Residents delivered the indicated care an average of 78.4% (95% CI, 77.4 to 79.4) of the time for all 10 indicators, which was significantly higher than previously reported data of asthma care provided by community physicians (p=0.0001). Although this population is at risk for significant health disparities, residents were able to provide a higher quality of care than reported at a national level.