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PEDIATRICS Vol. 113 No. 3 March 2004, pp. e230-e237

ELECTRONIC ARTICLE

Behind Schedule: Improving Access to Care for Children One Practice at a Time

Greg D. Randolph, MD, MPH*, Mark Murray, MD, MPA{ddagger}, Jill A. Swanson, MD§ and Peter A. Margolis, MD, PhD*

* North Carolina Center for Children’s Healthcare Improvement, Chapel Hill, North Carolina
{ddagger} Mark Murray and Associates, Sacramento, California
§ Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota

Access to health care, the timely use of personal health services to achieve the best possible health outcomes, remains a fundamental problem for children in the United States. To date, research and interventions addressing children’s access to care have largely focused on policy-level features of the health care system (such as health insurance and geographic availability of providers) with some, although limited, success. Ultimately, access to health care implies entry into the health care system. Practice scheduling systems are the point of entry to primary care health services for children and thus directly determine access to care in pediatric and family medicine practices. Here we explore the rationale for improving access to care for children from an additional angle: through improving practice scheduling systems. It is our hypothesis that some of the most promising contemporary interventions to improve children’s access involve improving primary care scheduling systems. These approaches should complement successful policy-level interventions to improve access to care for children.

Key Words: primary care practices • access to care • quality improvement

Abbreviations: IOM, Institute of Medicine • QI, quality improvement • SCHIP, State Children’s Health Insurance Program

Received for publication Aug 6, 2003; Accepted Nov 20, 2003.


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