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Wednesday, October 10, 2007

Children get recommended care less than half the time

Children get recommended care from their doctors less than half the time, leaving them even worse off than adults, concludes an analysis of medical care in 12 cities including Boston.

Researchers from the University of Washington, RAND and UCLA reviewed the medical records of more than 1,500 children and evaluated the quality of care they got as outpatients. They chose 175 quality indicators, from prescribing asthma medications to immunizing against childhood diseases to screening for sexually transmitted diseases.

To measure quailty, they divided the number of times the children's charts showed that recommended care was ordered or given by the number of times the care was warranted, based on national guidelines for screening, diagnosis, treatment and follow-up.

Overall, children received recommended care 46.5 percent of the time, they write in tomorrow's New England Journal of Medicine. That compares with a rate of 54.9 percent for adults.

When children had acute medical problems, they got the right services 67.6 percent of the time. For chronic conditions, they were given the indicated care 53.4 percent of the time. That falls to 40.7 percent for preventive care.

The authors note that research and policy devoted to children have concentrated more on expanding access to healthcare for children than on providing the right care.

"Deficits in the delivery of care must be identified if appropriate strategies to close the gaps are to be developed and implemented," they write.

Dr. James M. Perrin and Dr. Charles J. Homer of Harvard Medical School called the findings "shocking," while pointing out the study's limitations. Some of the data are 10 years old and failures in keeping accurate medical records may be a factor in the "dismal story," they write in an accompanying editorial.

"Services are not delivered when they should be, or they are delivered when they should not be," Perrin and Homer say in their editorial, also in tomorrow's journal. "Although one could challenge the precise 46.5 percent value for the percentage of overall care delivered, one cannot avoid the main observation that there exists a yawning chasm in the quality of health care provided to children."

Posted by Elizabeth Cooney at 06:45 PM
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