Background. Urinary tract infections (UTIs) occur commonly in children
and may lead to substantial morbidity. Most experts recommend urine c
ultures for diagnosing UTIs in children. In addition, most experts rec
ommend imaging studies in a portion of children diagnosed with UTIs. P
urpose. The purpose of this study was to assess how rates of performan
ce of urine cultures and imaging studies for children in the Alabama M
edicaid program diagnosed with a UTI vary by patient demographics, pro
vider characteristics, and service locations. Methods. The study desig
n was a retrospective review of Alabama Medicaid claims data. Children
were included as UTI cases if they had a Medicaid claim for urinary t
ract infections during 1991, were continuously enrolled in Medicaid fo
r that year, and were younger than 8 years of age. Claims were grouped
into episodes of care, and episodes were assigned to a diagnosing phy
sician. Physician locations were classified as rural, suburban, or urb
an using demographic data. Specific laboratory and imaging procedures
were identified using CPT codes (Physician's Current Procedural Techno
logy Codes, 4th Edition). Results. We identified 404 episodes of UTI o
ccurring in 380 children. Only 47% of episodes were associated with cl
aims for urine cultures. Claims for urine cultures were more frequentl
y filed by pediatricians in urban locations. In the subset of 114 pati
ents with multiple UTI episodes, only 68% had imaging studies specific
for the urinary tract. Only 44% received both a voiding cystourethrog
ram and renal ultrasound. Conclusions. Claims data suggest that physic
ians underuse urine cultures in diagnosing UTIs in Alabama pediatric M
edicaid recipients. Urban-based pediatricians perform better than othe
r types of physicians. Imaging studies are also used less frequently t
han is commonly recommended.