title: Service quality and attrition: an examination of a pediatric obesity program.
abstract: OBJECTIVE
  To examine the demographic, illness, and quality of care determinants of service attrition in a pediatric obesity program, and to elucidate factors that may promote families' return to care.
  
  
  METHODS
  Cross-sectional survey with semi-structured interviews.
  
  
  METHODS
  A regional children's hospital in the United States.
  
  
  METHODS
  Caregivers of 163 patients, consecutively enrolled in a pediatric obesity treatment program between January 1998 and September 2000, were contacted by telephone and offered participation in a survey of clinical care experiences. A total of 120 (74%) families participated.
  
  
  METHODS
  Service attrition as defined as premature discontinuation of treatment before completing phase I of a multi-phase treatment program.
  
  
  RESULTS
  Multivariate results indicated that service attrition was associated with both insurance status and perceived quality of care. Patients with government-subsidized insurance were more likely to defect from services than those with commercial insurance. Perceived quality of care was highly associated with attrition after controlling for demographic and health parameters. Caregiver-reported reasons for service attrition included difficulty with adequate insurance coverage (53%), the child's desire to leave the program (50%), and the program taking too much time (32%). The most frequent suggestions to facilitate families' return to the program were: (i) assistance with insurance coverage; (ii) following up with families; and (iii) increasing engagement with the child.
  
  
  CONCLUSIONS
  This study found few demographic differences between patients completing the program and those defecting from services. Both families completing the program and those discontinuing prematurely rated the overall quality of the program as high. However, lower quality of care was related to increased service attrition even after controlling for the effects of demographic and health parameters. Although a considerable number of patients discontinued services, very few reported that they would not return to the program. The results provide further support for ongoing audit and examination of families' care perceptions in preventing attrition and promoting service recovery.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. max.cote@chmcc.org
authors.forename: Max P
authors.initials: MP
authors.lastname: Cote
authors.forename: Terri
authors.initials: T
authors.lastname: Byczkowski
authors.forename: Uma
authors.initials: U
authors.lastname: Kotagal
authors.forename: Shelley
authors.initials: S
authors.lastname: Kirk
authors.forename: Meg
authors.initials: M
authors.lastname: Zeller
authors.forename: Stephen
authors.initials: S
authors.lastname: Daniels
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009765:Obesity / Q000628:therapy*; D010349:Patient Compliance; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014481:United States