Adherence to AAP guidelines for well-child care under managed care

Objectives. To determine adherence to American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care in Monroe County, New York by individual patients and individual pediatricians under managed care practice and to compare adherence-to-recommendations rates for privately i nsured and publicly funded managed care patients. Study Designs and Methods. Using claims data for children 0 through 18 year s of age cared for by pediatricians, we compared adherence to well-child ca re (WCC) visit recommendations for 130 572 children enrolled in a privately insured managed care system during 1992, 1993, and 1994 to 17 586 children insured by a publicly funded, Medicaid-managed care system during 1994 and 1995. Criteria for WCC visit adherence were based on 1991 AAP guidelines o f 19 office visits from birth through 18 years of age. Adherence-to-recomme ndations rates by individual pediatricians also were determined. Results. Despite complete financial coverage of WCC visits (with no co-paym ent or deductible charges) by both insurance systems, strict adherence to A AP guidelines for WCC visits was low. Only 46% of privately insured and 35% of publicly funded children received all the recommended visits during the study period. During the same period, 17% of privately insured and 35% of publicly funded managed care patients received no WCC. There was little dif ference in the rate of full WCC visit adherence by age in either system wit h the rates ranging in privately insured patients from 49% in infants (< 2 years of age) to 47% in adolescents (12 through 18 years of age) and rangin g in publicly funded patients from 36% to 34% in these two age groups, resp ectively. Only 2% of privately insured infants had no record of WCC compare d with 29% of adolescents. This contrasted with 12% of infants and 54% of a dolescents who were publicly funded. Of pediatricians, <5% achieved 100% ad herence to AAP guidelines for their patients (privately insured or publicly funded). Pediatricians completed an average of 52% of the recommended visi ts with their publicly funded patients and 68% of the recommended visits wi th their privately insured patients. Conclusions. WCC visits were underutilized for children in both managed car e systems. Children of parents who have low incomes presumably could benefi t greatest by preventive visits, but these children were less likely to rec eive the recommended number of WCC visits. Finding ways to increase the num ber of WCC visits that all children make is a major challenge, as is conduc ting studies that prove their worth.