Tags

Type your tag names separated by a space and hit enter

Physician credentials and practices associated with childhood immunization rates: private practice pediatricians serving poor children in New York City.
J Urban Health. 2001 Mar; 78(1):112-24.JU

Abstract

Private practice physicians in New York City's poorest neighborhoods are typically foreign trained, have generally substandard clinical practices, and have been accused of rushing Medicaid patients through to turn a profit. However, they also represent a sizable share of physician capacity in medically underserved neighborhoods. This article documents the level of credentials, systems, and immunization-related procedures among these physicians. Furthermore, it assesses the relationship between such characteristics and childhood immunization rates. The analysis utilizes a cross-sectional comparison of immunization rates in 60 private practices that submitted 2,500 or more Medicaid claims for children. Immunization data were gathered from medical records for 2,948 randomly selected children under 3 years of age. Half of sampled physicians were board certified (55%), and half were accepted by the Medicaid Preferred Physicians and Children (PPAC) program (51.7%). Of physicians, 43% saw patients only on a walk-in basis, while only 17% scheduled the next appointment while the patient was still in the office. There were 75% of the physicians who reported usually immunizing at acute care visits. Immunization rates were higher among PPAC physicians compared to others (41% vs. 29% up to date for diphtheria and tetanus toxoids and pertussis [DTP]/Haemophilus influenzae type b [Hib], polio, and measles-mumps-rubella [MMR], P = .01), and board-certified physicians showed a trend toward better immunization rates (39% vs. 30%, P =.07). Physicians who reported usually immunizing at acute care visits also had higher rates than those who did not (38% vs. 27%, P = .05). Scheduling a date and time for the next immunization showed a trend toward association with immunization coverage (37% vs. 28%, P= .10). Private practice physicians who provide high volumes of care reimbursed by Medicaid have improved their credentials and affiliations over time, thereby expanding reimbursement options. Credentials and affiliations were at least as effective in distinguishing relatively high- and low-performing physicians, as were immunization-related practices, suggesting that they are useful markers for higher quality care. The relative success of the PPAC program should inform efforts to improve the capacity and quality of primary care for vulnerable children. Appointment and reminder systems that effectively manage the flow of children back into the office for immunizations and the vigilant use of acute care visits for immunizations go hand in hand. Opportunity exists for payers and plans to encourage and support these actions.

Authors+Show Affiliations

Robert J. Milano Graduate School of Management and Urban Policy, New School University, New York, NY 10011, USA. hansonk@newschool.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11368191

Citation

Hanson, K L., et al. "Physician Credentials and Practices Associated With Childhood Immunization Rates: Private Practice Pediatricians Serving Poor Children in New York City." Journal of Urban Health : Bulletin of the New York Academy of Medicine, vol. 78, no. 1, 2001, pp. 112-24.
Hanson KL, Butts GC, Friedman S, et al. Physician credentials and practices associated with childhood immunization rates: private practice pediatricians serving poor children in New York City. J Urban Health. 2001;78(1):112-24.
Hanson, K. L., Butts, G. C., Friedman, S., & Fairbrother, G. (2001). Physician credentials and practices associated with childhood immunization rates: private practice pediatricians serving poor children in New York City. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 78(1), 112-24.
Hanson KL, et al. Physician Credentials and Practices Associated With Childhood Immunization Rates: Private Practice Pediatricians Serving Poor Children in New York City. J Urban Health. 2001;78(1):112-24. PubMed PMID: 11368191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physician credentials and practices associated with childhood immunization rates: private practice pediatricians serving poor children in New York City. AU - Hanson,K L, AU - Butts,G C, AU - Friedman,S, AU - Fairbrother,G, PY - 2001/5/23/pubmed PY - 2001/6/29/medline PY - 2001/5/23/entrez SP - 112 EP - 24 JF - Journal of urban health : bulletin of the New York Academy of Medicine JO - J Urban Health VL - 78 IS - 1 N2 - Private practice physicians in New York City's poorest neighborhoods are typically foreign trained, have generally substandard clinical practices, and have been accused of rushing Medicaid patients through to turn a profit. However, they also represent a sizable share of physician capacity in medically underserved neighborhoods. This article documents the level of credentials, systems, and immunization-related procedures among these physicians. Furthermore, it assesses the relationship between such characteristics and childhood immunization rates. The analysis utilizes a cross-sectional comparison of immunization rates in 60 private practices that submitted 2,500 or more Medicaid claims for children. Immunization data were gathered from medical records for 2,948 randomly selected children under 3 years of age. Half of sampled physicians were board certified (55%), and half were accepted by the Medicaid Preferred Physicians and Children (PPAC) program (51.7%). Of physicians, 43% saw patients only on a walk-in basis, while only 17% scheduled the next appointment while the patient was still in the office. There were 75% of the physicians who reported usually immunizing at acute care visits. Immunization rates were higher among PPAC physicians compared to others (41% vs. 29% up to date for diphtheria and tetanus toxoids and pertussis [DTP]/Haemophilus influenzae type b [Hib], polio, and measles-mumps-rubella [MMR], P = .01), and board-certified physicians showed a trend toward better immunization rates (39% vs. 30%, P =.07). Physicians who reported usually immunizing at acute care visits also had higher rates than those who did not (38% vs. 27%, P = .05). Scheduling a date and time for the next immunization showed a trend toward association with immunization coverage (37% vs. 28%, P= .10). Private practice physicians who provide high volumes of care reimbursed by Medicaid have improved their credentials and affiliations over time, thereby expanding reimbursement options. Credentials and affiliations were at least as effective in distinguishing relatively high- and low-performing physicians, as were immunization-related practices, suggesting that they are useful markers for higher quality care. The relative success of the PPAC program should inform efforts to improve the capacity and quality of primary care for vulnerable children. Appointment and reminder systems that effectively manage the flow of children back into the office for immunizations and the vigilant use of acute care visits for immunizations go hand in hand. Opportunity exists for payers and plans to encourage and support these actions. SN - 1099-3460 UR - https://www.unboundmedicine.com/medline/citation/11368191/Physician_credentials_and_practices_associated_with_childhood_immunization_rates:_private_practice_pediatricians_serving_poor_children_in_New_York_City_ L2 - https://dx.doi.org/10.1093/jurban/78.1.112 DB - PRIME DP - Unbound Medicine ER -