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Health Care For Children Rated Poorly In Study

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By LINDA A. JOHNSON, The Associated Press

Published: October 11, 2007

A study finds that children who regularly see doctors get the right care less than half the time - whether it's preschool shots or chlamydia tests for teenage girls.

The findings, from the first comprehensive look at children's health care quality, are particularly troubling because nearly all of the 1,536 children in the nationwide study had insurance.

Eight-two percent were covered by private insurance. Three-quarters were white, and all lived in or near large or midsize cities.

Two experts called the findings 'shocking.' Others said minority children, those with more-restrictive government insurance, and the millions with no insurance certainly fare worse.

The study, by the Seattle Children's Hospital Research Institute and the nonprofit Rand Corp. research group, concludes that overall, doctors gave children the appropriate outpatient medical care only 47 percent of the time.

'They got an F,' said Joseph Hagan, a Burlington, Vt., pediatrician. Hagan co-edited the American Academy of Pediatrics' latest update to its children's health guidelines, due out this month.

'It's sad, but I think it reflects some unpleasant realities about our current health care system or, I might say, non-system,' Hagan said.

The compliance rate was worse than that found in a study of adults: They got only 55 percent of recommended care.

The research found children's doctors did best in providing the recommended care for acute medical problems - 68 percent. They scored just 53 percent for treating chronic conditions and 41 percent for preventive care.

Basics 'Just Not Happening'

'I was really taken aback by the results for preventive care,' said Rita Mangione-Smith, lead investigator at the Seattle institute and an associate professor at the University of Washington. 'It was really kind of distressing to me that there was some really basic stuff that we should be doing that's just not happening.'

The study, based on a review of two years of medical records of children in 12 metropolitan areas, was reported in the New England Journal of Medicine.

Data were collected from late 1998-2000. Experts said it's unlikely children's health care has improved since then.

Researchers found a huge variance in the rates at which doctors provided care recommended for common illnesses and for promoting health.

Children got the right care 92 percent of the time for upper respiratory infections and 85 percent of the time for hay fever. But they got it only 48 percent of the time for urinary tract infections, 46 percent for asthma and 35 percent for adolescent preventive care.

For instance, only 15 percent of adolescents seen by a doctor got weighed annually. Yet about one-third of American children are overweight and many are developing high blood pressure and diabetes, setting themselves up for long-term health problems.

'There can be dire consequences for the children, for their families and for society as a whole,' including death, when these easily managed conditions are not controlled, said Julia Paradise of the Kaiser Family Foundation.

Study Of Care Vetoed

She noted the proposed expansion of the State Children's Health Insurance Program, which President Bush vetoed last week, was to include the first major initiative to measure and find ways to improve quality of care for children covered by that program and by Medicaid.

The study was funded by the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation of Plainsboro, N.J., and the California HealthCare Foundation.

Researchers noted they had incomplete medical records for some children, no children from rural areas were included, and more than half the families asked to participate didn't respond.

Mangione-Smith and the other experts said they hope the new findings will lead to action to address the shortcomings. Hagan said doctors can do more to keep up with the latest care guidelines. But he said they can't solve all of the problems, such as inadequate time pediatricians have to spend with each child.

Another big challenge, Mangione-Smith said, is to change pediatrician training, which now focuses on treating acute illnesses in a hospital.

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