Measuring primary care of children in pediatric resident continuity practices: A continuity research network study

OBJECTIVES. Pediatric resident continuity practices provide care to more than one fifth of the socioeconomically disadvantaged population of the United States. With the structural challenges of resident training, there may be concerns about a lower quality of care received by patients. The objectives of this study were to measure parental perception of resident primary care, to determine the characteristics associated with better care, and to compare perception with a previously published community standard. METHODS. A cross-sectional survey using the Parents' Perception of Primary Care was conducted of patients enrolled at 19 national academically affiliated resident continuity practices from the Continuity Research Network. Outcome measures included mean total scale score for the Parents' Perception of Primary Care and mean scores for each primary care domain. Comparisons were made between the subset of resident patients who were older than 5 years and a previously published community survey of parents of school-age children. RESULTS. A total of 2572 patients were enrolled with a final sample size of 2211 analyzable surveys. The sample was 37% black and 40% Hispanic; 81% of the children had Medicaid insurance; and 20% of the parents had less than a high school education. Parents rated the care that they received in resident continuity with high total scores and subscale scores, with an overall mean total scale score of 74.0. Higher scores were associated with number of visits to the provider and being able to name the resident as the primary care provider, whereas minority status was associated with lower access and communication scores. The resident sample over age 5 had higher mean scores for the total scale and every domain as compared with the community sample. CONCLUSIONS. Parents of patients at resident continuity sites rated residents as providers of high-quality care to a socioeconomically disadvantaged population as compared with a previously published community sample. Efforts to improve resident continuity and identification may help improve care delivered in resident practices.