WASHINGTON — In the largest study of its kind, researchers found that America's children received appropriate medical care only 46 percent of the time when they visit health professionals, faring even worse than adults and raising serious questions about the quality of care delivered by the world's most expensive health system.
The study, to be published in the Oct. 11 issue of the New England Journal of Medicine, was conducted by the RAND Corp., the Seattle Children's Hospital Research Institute and the University of Washington School of Medicine.
It followed the health care experiences of 1,536 children from 12 metropolitan areas over a four-year period. By interviewing the youngsters' parents, reviewing the children's medical records and comparing their treatments to established care standards, researchers found that even basic care was a hit-or-miss proposition for children who visit hospitals and pediatricians.
The study found only 19 percent of seriously ill infants with fevers had the right lab tests done, only 44 percent of youngsters with asthma were on the right medications and only 38 percent of youngsters were screened for anemia in their first two years of life.
In addition, only 31 percent of children ages 3-6 have their weight measured at annual checkups.
Failure to provide proper care makes it harder to reverse illnesses and increases the chance that youngsters will carry health problems into adulthood.
"How do we catch a child at risk for obesity if we don't look," said co-author Dr. Rita Mangione-Smith, an associate professor of pediatrics at the University of Washington School of Medicine.
The results are surprising, not least because most of the youngsters in the study were white, middle-class and had health insurance.
"These are the kids who most people assume are getting excellent care in this country, and unfortunately they're not," Mangione-Smith said.
Ironically, the study's dearth of low-income and ethnically diverse youngsters likely skewed the final data, resulting in an "overly rosy" picture, Mangione-Smith said.
"As a pediatrician, I was shocked by some of our findings," she added. "I even re-screened several of the charts because I just couldn't believe the results we were getting. And unfortunately, they were accurate."
A 2006 RAND study found that adults get appropriate medical care about 55 percent of the time.
But the new study found that youngsters get appropriate care for acute illnesses, such as fevers, only 68 percent of the time and proper care for chronic conditions, such as attention deficit disorder, only 53 percent of the time.
Proper preventative care, the bread and butter of pediatric practice, was provided in only 41 percent of check-ups. Researchers gauged quality of treatment against 175 standards of care that cover 12 clinical areas.
"It is unconscionable that we spend $2 trillion on health care, more than any nation in the world, and get these results," said co-author Elizabeth McGlynn, an associate director of RAND Health. "We can do better, but this will not happen without serious sustained effort. This study tells us that it is time to begin."
Part of the problem stems from insurance company pressure on physicians to see more patients in less time, typically allowing only 10 minutes for a child's check-up. The problem is worse for doctors practicing alone or in small practices with no support staff, McGlynn said.
Pediatric residency training is also a problem because it focuses on caring for very sick children rather than on the basics of preventative care.
McGlynn said Congress' proposal to boost funding for the State Children's Health Insurance Program by $35 billion would require the Department of Health and Human Services to develop a set of quality pediatric-care measures to monitor services provided by Medicaid and the SCHIP program. McGlynn said the provisions would have a "large impact on both access and quality of care that those children receive."
President Bush vetoed the SCHIP legislation, but House of Representatives Democrats are expected to try to override him next week.
ON THE WEB
For a look at the study in the New England Journal of Medicine, go to www.nejm.com.