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Author ORCID Identifier

N/A

AccessType

Open Access Dissertation

Document Type

dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded

2018

Month Degree Awarded

September

First Advisor

Lisa Wexler

Second Advisor

Aline Gubrium

Third Advisor

Laurel Smith-Doerr

Fourth Advisor

Penelope Pekow

Subject Categories

Health Services Research | Medicine and Health

Abstract

The research conducted for this dissertation broadly explored the relationship between characteristics of healthcare organizations and quality and equity in pediatric healthcare. The first of the three studies identified characteristics of pediatric practices with high scores on measures of quality and patient experience using qualitative methods. The second study assessed whether the candidate characteristics identified in the first study were quantitatively associated with performance on quality measures using a statewide survey and publicly available quality data. This study found several potentially modifiable factors associated with performance, including an organizational culture characterized by good communication and interpersonal relationships amongst providers and staff, having a designated quality champion, and offering co-located ancillary services, such as behavioral health. The third study used ethnographic-style methods to explore implementation of community health workers in a pediatric practice in a new Medicaid accountable care organization. Observations and interviews identified a number of potential barriers to effective planning for integration of the community health workers, which could in turn limit the capacity of the community health worker program to improve quality and address inequities in healthcare for low-income children.

DOI

https://doi.org/10.7275/12627498

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