Methods for evaluating the provision of well child care

Area of Science:

• Health Services Research
• Pediatric Health Outcomes
• Healthcare Quality Measurement

Background:

• Well child visits are crucial for preventing illness and disease.
• The Omnibus Reconciliation Act of 1989 (OBRA '89) established goals for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visits.
• Health plan evaluations often rely on well child visit data, but data collection methods impact results.

Purpose of the Study:

• To compare medical record review and administrative data for ascertaining well child visits.
• To assess compliance with American Academy of Pediatrics (AAP) preventive care guidelines.
• To evaluate the accuracy of administrative data in representing actual healthcare delivery.

Main Methods:

• Retrospective cohort design.
• Comparison of medical record review versus administrative data.
• Analysis of Iowa Medicaid-eligible children's visits from July 1997 to December 1998.

Main Results:

• Administrative data identified 29.6% of children with well child visits, while medical record review found 39.6%.
• Concordance between the two methods was low (kappa = 0.30).
• Only 68% of billed EPSDT encounters were confirmed as actual well child visits via medical record review.

Conclusions:

• Administrative data may underestimate EPSDT visit performance compared to medical record review.
• A claim for an EPSDT visit does not guarantee the child received essential well child exam components.
• Methodologies for health plan performance indicators require careful validation to ensure accuracy.