The better model to predict and improve pediatric health care quality: performance or importance-performance?
BACKGROUND
The perpetual search for ways to improve pediatric health care quality has resulted in a multitude of assessments and strategies; however, there is little research evidence as to their conditions for maximum effectiveness. A major reason for the lack of evaluation research and successful quality improvement initiatives is the methodological challenge of measuring quality from the parent perspective.


OBJECTIVE
Comparison of performance-only and importance-performance models was done to determine the better predictor of pediatric health care quality and more successful method for improving the quality of care provided to children.


METHODS
Fourteen pediatric health care centers serving approximately 250,000 patients in 70,000 households in three West Central Florida counties were studied. A cross-sectional design was used to determine the importance and performance of 50 pediatric health care attributes and four global assessments of pediatric health care quality. Exploratory factor analysis revealed five dimensions of care (physician care, access, customer service, timeliness of services, and health care facility). Hierarchical multiple regression compared the performance-only and the importance-performance models. In-depth interviews, participant observations, and a direct cognitive structural analysis identified 50 health care attributes included in a mailed survey to parents(n = 1,030). The tailored design method guided survey development and data collection.


RESULTS
The importance-performance multiplicative additive model was a better predictor of pediatric health care quality.


CONCLUSIONS
Attribute importance moderates performance and quality, making the importance-performance model superior for measuring and providing a deeper understanding of pediatric health care quality and a better method for improving the quality of care provided to children. Regardless of attribute performance, if the level of attribute importance is not taken into consideration, health care organizations may spend valuable resources targeting the wrong areas for improvement. Consequently, this finding aids in health care quality research and policy decisions on organizational improvement strategies.
Rebecca M. Olsen, PhD, is Associate Professor of Public Health, Health Science and Human Performance, College of Natural and Health Sciences, University of Tampa, Florida. E-mail: Rolsen@ut.edu. Carol A. Bryant, PhD, is Distinguished USF Health Professor in Community and Family Health, Co-Director, Florida Prevention Research Center, College of Public Health, University of South Florida, Tampa. Robert J. McDermott, PhD, is Professor of Health Education and Public Health, Co-Director, Florida Prevention Research Center, College of Public Health, University of South Florida, Tampa. David Ortinau, PhD, is Professor of Marketing, College of Business Administration, University of South Florida, Tampa.
Rebecca M
RM
Olsen
Carol A
CA
Bryant
Robert J
RJ
McDermott
David
D
Ortinau
D002648:Child; D003430:Cross-Sectional Studies; D005431:Florida; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D010372:Pediatrics / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards