Children Receive Proper Outpatient Care 47% Of The Time

Armen Hareyan's picture

Children receive proper outpatient care 47% of the time, according to a study published on Thursday in the New England Journal of Medicine, USA Today reports (Elias, USA Today, 10/11). For the study, researchers at RAND, the Seattle Children's Hospital Research Institute and the University of Washington School of Medicineexamined the medical records of 1,536 children in 12 metropolitan areasand compared their treatment to 175 established standards of care in 12clinical areas (Pugh, McClatchy/Arizona Republic, 10/11).

The study, led by Rita Mangione-Smith of the Seattle Children's Hospital Research Institute, used data from 1996 to 2000 (USA Today,10/11). Three-fourths of study participants were white, 82% had privatehealth insurance and all lived in or near large- or mid-sized cities.

According to the study, participants received proper care for acute conditions about 68% of the time (Johnson, AP/Houston Chronicle,10/10). Participants received proper care for chronic conditions about53% of the time and received proper preventive care 41% of the time,the study found.

In addition, the study found:

  • Fewer than one-third of participants ages three to six had their height and weight measured over two years (USA Today, 10/11);
  • Participants received proper care for severe diarrhea 38% of the time (Black/Nyhan, Seattle Post-Intelligencer, 10/10).
  • Participants received proper care for upper respiratory infections 92% of the time and for hay fever 85% of the time;
  • Participants received proper care for urinary tract infections 48% of the time;
  • Participants received proper care for asthma 46% of the time; and
  • About35% of teenage participants received proper preventive care, and only15% of those participants had their height and weight measured annually(AP/Houston Chronicle, 10/10).

Mangione-Smithsaid that the study results represent the "best-case scenario" becausemost of the participants had health insurance (Ostrom, Seattle Times,10/11). Researchers attributed the results of the study to physiciantraining, which focuses on care for acute conditions, and to thereimbursement policies of health insurers, which often do not coverpreventive care (USA Today, 10/11).


CMS, the Robert Wood Johnson Foundation and the California HealthCare Foundation funded the study (AP/Houston Chronicle, 10/10).


Mangione-Smith said, "As a pediatrician, I was shocked by some of our findings" (Stewart, Newark Star-Ledger,10/11). She said, "That almost all of the kids in the study had healthinsurance yet still failed to get good care is pretty disturbing,"adding, "This study shows that health care quality for kids is an issuein itself" (Feder Ostrov, San Jose Mercury News, 10/11).

Studyco-author Elizabeth McGlynn, an associate director at RAND, said thatthe study "is a real wake-up all for the American public." She added,"The care for kids is way below what many of us as parents would hopeto see" (LaMendola, South Florida Sun-Sentinel, 10/11).

Julia Paradise of the Kaiser Family Foundationsaid, "There can be dire consequences for the children, for theirfamilies and for society as a whole" when chronic conditions are nottreated properly (AP/Houston Chronicle, 10/10).

James Perrin -- chief of general pediatrics at Massachusetts General Hospital and a professor at Harvard Medical School,who wrote an editorial that accompanied the study -- called the results"shocking." Perrin said, "We've been lulled into complacency, thinkingthis kind of thing doesn't happen with children," but "we need muchmore accountability for what's going on with children's health" (USA Today, 10/11).

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