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We already know that US adults receive relatively poor quality health care. The nation's children do no better, according to quality analysis of outpatient data. Over two years, a random sample of 1536 children received less than half the care they needed (46.5%, 95% CI 44.5% to 48.4%). Deficits were most obvious for preventive services (40.7%, 38.1% to 43.4%), screening (37.8%, 34.6% to 41.0%), and diagnostic tests (36.3%, 29.8% to 42.7%). But the researchers found a mismatch between recommended and received care in most areas including acute illnesses such as diarrhoea, chronic illnesses such as asthma, and immunisations.
The researchers used medical records to link what children needed with the care they received for 175 quality indicators covering common childhood illnesses and services. Their findings are shocking, says an editorial (p 1549). Contrary to the prevailing view, quality of outpatient care for children in the US looks dismal across the board, and must be having an adverse effect on children's health.
Medical records can be inaccurate, but these authors analysed only those items most likely to be recorded. So it's hard to blame poor note keeping for the results.