Summaries of Independent Scientist (K) Awards

Mayer, Michelle

Institution: The University of North Carolina at Chapel Hill
Grant Title: Access to Pediatric Subspecialty Care in the USA
Grant Number: K02 HS0133090
Duration: 4 years (2003-2007)
Total Award: $293,675

Project Description: This project has 5 main goals:

1. To depict the practice location of pediatric and adult subspecialists.
2. To explore the relationship between county characteristics and access to pediatric subspecialty care.
3. To ascertain the extent to which adult subspecialists expand access to care for children with rheumatic diseases.
4. To describe the practice patterns of subspecialists, their comfort with treating a variety of pediatric conditions, and the practice, provider, and market characteristics that influence their decisions to treat pediatric patients.
5. To determine the independent effects of selected training, personal, and practice characteristics on the likelihood that an adult subspecialist treats pediatric patients.

In addition, two pilot studies that explore the role of general pediatricians in treating children with rheumatic conditions and compare care received across physician management types for children with JRA will be conducted.

Career Goals: Dr. Mayer is interested in exploring access to pediatric subspecialty care for children with chronic conditions. She envisions her career logically progressing from descriptive analyses of subspecialty access through the evaluation of interventions aimed at expending access to care for chronically ill pediatric populations.

Progress to Date:

Review: The first goal with this award was to perform a systematic review of the pediatric subspecialty literature with regard to access and quality. After reviewing this literature, it became clear that there were three distinct review topics: the adequacy of the pediatric subspecialty workforce, the role of insurance coverage in ensuring access to pediatric subspecialty services, and differences between pediatric subspecialists and other providers, specifically primary care physicians and adult subspecialists, in terms of their knowledge, attitudes and practice patterns.

Dr. Mayer identified 6 index conditions, including sickle cell anemia, cystic fibrosis, seizure disorders, ADHD, congenital heart disease, and moderate to severe asthma, and will survey general pediatricians on their involvement in the care of these conditions.

The Changing Composition of the Pediatric Subspecialty Workforce: This analysis looked at trends in the roles of women and international medical graduates in the pediatric subspecialty workforce and found significant increases in the representation of women among the pediatric subspecialties over the past two decades.

Are We There Yet? The Distance Children Travel to Pediatric Subspecialty Care in the U.S.: This study combined data from the American Board of Pediatrics and Claritas to calculate the distance between each zip code in the USA and the nearest provider for each pediatric subspecialty.

The Supply of Pediatric Medical Subspecialists in the U.S.: Data from the American Board of Pediatrics, Claritas, and the Dartmouth Atlas were used to calculate provider to population ratios for each of 16 pediatric medical subspecialties. Over the next year, Dr. Mayer will develop specialty-specific provider location maps that depict the distribution of pediatric subspecialists in the United States relative to their internal medicine counterparts. Also, the grantee will investigate additional studies, not planned during the original application. These analyses are not dependent on receipt of additional funding.

Highlights and Specific Accomplishments:

• Research Fellow, Cecil G. Sheps Center for Health Services Research (HSR), University of North Carolina (UNC).
• Research Assistant Professor, Department of Health Policy and Administration, UNC.
• Professional Organizations:
  • Member, Association for Health Services Research, 1995-present.
  • Recipient, United States Public Health Service Traineeship, 1990-1991, 1992-1993.
  • Registered Nurse, State of North Carolina, 1990-present.
  • Member, Delta Omega, 1996-present.
  • Member, Sigma Theta Tau, 1990-present.
  • Reviewer, Ambulatory Pediatrics.
  • Reviewer, Archives of Pediatrics and Adolescent Medicine.
  • Reviewer, Pediatrics.
  • Reviewer, Health Services Research.
  • Reviewer, Journal of Health Care for the Poor and Underserved.
  • National Research Service Award (NRSA) Pre-Doctoral Fellowship.
  • National Research Service Award (NRSA) Post-Doctoral Fellowship.

K-Generated Publications:

• Dusing SC, Skinner AC, Mayer ML. Unmet Need for Therapy Services, Assistive Devices and Related Services: Data from the National Survey of Children with Special Health Care Needs. Ambulatory Pediatrics 2004;4(5):448-54.
• Mayer ML, Skinner AC. Too Many, Too Few, Too Concentrated? A Review of the Pediatric Subspecialty Workforce Literature. Archives of Pediatrics and Adolescent Medicine 2004;158(12):1158-65.
• Mayer ML, Slifkin RT, Skinner AC. Rural Residence and Perception of Need for Preventive and Specialty Care Among Children with Special Health Care Needs. Medical Care Research and Review (in press).
• Skinner AC, Slifkin RT, Mayer ML. The Effect of Rural Residence on Dental Unmet Need for Children with Special Health Care Needs. Journal of Rural Health (in press).
• Mayer ML, Brogan LA, Sandborg CI. Availability of Pediatric Rheumatology Training in U.S. Pediatric Residencies. Arthritis Care and Research (in press).
• Skinner AC, Slifkin RT, Mayer ML. The Effect of Rural Residence on Dental Unmet Need for Children with Special Health Care Needs. Journal of Rural Health 22(1):36-42.
• Bergman DA, Mayer ML, Pantell RH, Finch SA, Wasserman RC. Does Patient Presentation Explain Practice Variability in the Treatment of Febrile Infants? Pediatrics 2006;117(3):787-95.
• Mayer ML, Slifkin RT, Skinner AC. Rural Residence and Perception of Need for Preventive and Specialty Care Among Children with Special Health Care Needs. Medical Care Research and Review 2005;62(5):617-28.
• Mayer ML Preisser JS. The Changing Composition of the Pediatric Subspecialty Workforce. Pediatrics 2005;116(4):833-40.

Return to Recently Funded Career Development Award Grants
Proceed to Next Section