Posted by: shoji | October 11, 2007

Children’s health care: not making the grade

This is embarrassing.

A New England Journal of Medicine article details some of the mass deficiencies in U.S. pediatric health care. And our physicians (and health care system) do not make the grade.

For example, only 44.0% of children with asthma who were noted to be using 2-agonists at least three times per day had a prescription for an antiinflammatory medication recorded in the chart…
Only 49.8% of children in our study who reached 2 years of age during the study period were fully immunized, according to their records…
According to chart data, urine cultures were obtained for 16.2% of children 3 to 36 months of age who presented with fever of unknown origin and who were thought to be at high risk for sepsis…
Only 41.5% of eligible adolescent girls in the current study had charts showing evidence of laboratory orders for tests for Chlamydia trachomatis or of the results of such testing…

The upshot of these examples is that quality of care is suboptimal: optimal care is not achieved (approximately) half the time– the proverbial coin flip.

Of course, the research study has a number of limitations. Nevertheless, the suboptimal delivery of care, as measured in earlier studies, found similar results.

Importantly, the qualitative results show that U.S health care can make extraordinary advances by implementing systems for proper delivery.

NEJM — The Quality of Ambulatory Care Delivered to Children in the United States
Results On average, according to data in the medical records, children in the study received 46.5% (95% confidence interval [CI], 44.5 to 48.4) of the indicated care. They received 67.6% (95% CI, 63.9 to 71.3) of the indicated care for acute medical problems, 53.4% (95% CI, 50.0 to 56.8) of the indicated care for chronic medical conditions, and 40.7% (95% CI, 38.1 to 43.4) of the indicated preventive care. Quality varied according to the clinical area, with the rate of adherence to indicated care ranging from 92.0% (95% CI, 89.9 to 94.1) for upper respiratory tract infections to 34.5% (95% CI, 31.0 to 37.9) for preventive services for adolescents.

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