Health Guidelines for Kids Are Skipped
Study Shows Children May Not Always Get Up-to-Date Treatment
Oct. 10, 2007 -- Less than half of the outpatient medical care delivered to
American children is in line with recommendations for the best treatment,
concludes a study released Wednesday.
The results, which researchers called "shocking," show that 47% of
the care delivered to children in doctors' offices and clinics meets
professional recommendations or is up to date scientifically.
The study -- conducted among 1,536 children in 12 cities -- comes four years
after similar research showing American adults receive recommended care 55% of
"No one anywhere is immune to the risk of poor-quality care," says
Elizabeth A. McGlynn, PhD, a researcher at RAND Corp. who worked on the
Two-thirds of children being treated for acute illnesses received
appropriate care, the researchers found after reviewing medical records.
But proper care for chronic conditions like asthma and diabetes was
delivered just half the time, while 41% of the children received recommended
preventive care, the study showed.
Researchers guessed that the results may actually underestimate the problem
because the study participants were primarily white and from wealthier
"I want to emphasize that the results of this study are the best-case
scenario," says researcher Rita Mangione-Smith, MD, MPH.
Mangione-Smith told reporters that just 31% of 3-year-old children in the
study received routine height and weight measurements at the pediatrician's
office. "As a pediatrician I was shocked by some of our findings," she
said. "I even rescreened some of the charts because I couldn't believe some
of the results we were getting."
The researchers in part blame doctors' overly tight schedules, which often
allow for 10-minute doctor visits that can crowd out needed care. They also say
pediatrician residency training tends to focus on treating serious illnesses in
the hospital, and not enough on prevention.
Joseph Hagan, MD, a co-author of soon-to-be released practice guidelines
from the American Academy of Pediatrics, says he disagrees with some of the
study's methods. But he also calls the conclusion that children receive
recommended care less than half the time "abysmal."
"I see this report as a little bit of a face slap, but we know there's
been a problem and this helps us get a sense of how to go and fix it," says
Hagan, a pediatrician in private practice in Burlington, Vt.
Hagan acknowledges that many pediatricians do not keep up to date on the
latest recommendations and findings. But he also blames insurance company
policies that pay doctors primarily for treating diseases and not for patient
education or disease screenings.
Researchers suggest that parents not rely on doctors to remember every point
of recommended screenings. Mangione-Smith urges parents to take a checklist
culled from the American Academy of Pediatrics web site or other sources to the
"Parents do need to be quite proactive about their child's health
care," Mangione-Smith says.
(Do you feel your child has good health care? Why or why not? Talk with
others on WebMD's Parenting:
Preschoolers and Grade Schoolers message board.)