Methods for evaluating the provision of well child care

Well child visits are important for reducing the incidence of avoidable illness and disease. The Omnibus Reconciliation Act of 1989 (OBRA '89) set goals for well child or Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visits. Many health plans are evaluated in terms of the number of well child visits provided, yet the method used for collecting the data influences the indicator results and conclusions drawn from them.

In a retrospective cohort design, medical record review and administrative data were compared as methods for ascertaining the number of well child visits received by Iowa Medicaid-eligible children for the period from July 1, 1997 through December 31, 1998. Compliance with the American Academy of Pediatrics' "Recommendations for Preventive Pediatric Health Care" periodicity guidelines was assessed.

Using administrative data, 29.6% (n = 1,489) of children received a well child visit. If medical record review was used, 39.6% (n = 1,003) of children had a visit. The concordance between the rates was quite low (kappa = 0.30). Medical record review supported that an EPSDT visit was provided for only 68% of the children who had a claim or encounter billed as providing well child care (n = 441).

Administrative data may underestimate the performance of EPSDT visits in comparison to medical record review. In addition, having a claim for an EPSDT visit did not necessarily mean the child received the basic components of a well child exam. The methodology for performance indicators used to evaluate health plans should be carefully validated.