In a large study, researchers looked at recommended guidelines for care of a variety of common conditions in children, including preventive care. They examined 175 measures of quality in over 1,500 children across the country. Most children were from middle to upper-class families and covered by private insurance. The overall conclusion of the study was that children received recommended health-care only 46% of the time.
This study is receiving widespread media coverage, particularly in these days of debate over healthcare in the United States. I am certain that this study is in some measures accurate; however, there are some problems with the study and with its potential conclusions.
First of all, the researchers developed the “quality measures” from published guidelines. Guidelines are great, but not every patient situation fits a guideline. Furthermore, not every physician agrees with every point of a guideline. Therefore is is often entirely appropriate that a particular point in a guideline was not used for a particular patient. Secondly, the study is based on chart review. That means that it must be documented in the chart in writing that a particular test was done or recommendation made. Doctors discuss many things with patients, and make many recommendations. However, for it to count in this study, the doctor had to write everything he or she recommended in the chart, such as, “Recommend continuing to breastfeed” for babies with diarrhea, or “Offered testing.” There is just no way, not even with transcriptionists or electronic medical records, to record every piece of advice or recommendation made to a patient. A chart review like this will fall far short of accurately recording what was actually done.
Unfortunately, many of the recommendations are things that pediatricians should be doing and may be underdone. Many doctors are rushing through patient visits, in part due to insurance companies forcing doctors to spend less time with patients and in part to doctors' desire to see more patients. Many of the recommendations measured require patients, particularly adolescents, to have routine care and follow-up appointments, which is a real problem but not the fault of doctors.
Still, even with the inaccuracies and problems with the study, it likely reveals that care of kids in the U.S. often falls short, due to a variety of reasons. We should all be more vigilant and careful to provide the best care possible to our children.
