Insured children in three New England states receive highly variable care, according to a new analysis from the Dartmouth Atlas.
Researchers from The Dartmouth Institute examined commercial and Medicaid data claims from Maine, New Hampshire and Vermont showing patterns for pediatric care. The report finds "many examples of excellent care, [though variations in care across the region] raise troubling questions about whether the medical practice patterns reflect the care that infants and children need and that their families want."
Office and clinic visits were roughly equal among all children in the study, though physicians responsible for pediatric care were often located in areas with the least burden of disease.
Researchers found discrepancies in several aspects of care. For instance, the annual emergency department visit rate was 3.59 percent, though more children on Medicaid (5.6 percent) visited the ED than children on commercial insurance (2.25 percent). Locally, ED visit percentages varied between 2.23 and 6.22 percent. ED visit percentages did not vary according to the payer mix, suggesting healthcare structure was a main contributing factor.
For effective care, 86 percent of insured children had at least one primary care visit per year. This figure ranged from just above 60 percent slightly to over 90 percent among the states. Approximately 47 percent of children 12 and over had one well-care visit in a year. This figured ranged from just under 30 percent to nearly 80 percent
The study also documented variations in care for common pediatric procedures including strep testing and antibiotic administration.
The report's author suggests a dearth of data has hindered progress in pediatric quality of care improvements, and a focus on data analysis is necessary to understand the problems plaguing pediatric care and mechanisms by which to solve them.
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