[Skip to Content]
[Skip to Content Landing]
Original Investigation
March 20, 2018

Quality of Health Care for Children in Australia, 2012-2013

Author Affiliations
  • 1Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  • 2Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
  • 3Australian Patient Safety Foundation, Adelaide, South Australia, Australia
  • 4School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
  • 5Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
  • 6Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
  • 7Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
  • 8Kids Research Institute, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
  • 9Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  • 10Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  • 11Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
  • 12Division of Paediatric Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
  • 13Russell Clinic, Blackwood, South Australia, Australia
  • 14Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
  • 15Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
  • 16New South Wales Ministry of Health, North Sydney, New South Wales, Australia
  • 17Clinical Excellence Division, Queensland Department of Health, Brisbane, Queensland, Australia
  • 18International Society for Quality in Health Care, Dublin, Ireland
  • 19Bupa Health Foundation Australia, Sydney, New South Wales, Australia
  • 20New South Wales Agency for Clinical Innovation, Chatswood, New South Wales, Australia
  • 21Clinical Excellence Commission, Sydney, New South Wales, Australia
  • 22London School of Hygiene and Tropical Medicine, London, United Kingdom
  • 23World Health Organization, Geneva, Switzerland
  • 24The University of Warwick, Coventry, United Kingdom
  • 25Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
JAMA. 2018;319(11):1113-1124. doi:10.1001/jama.2018.0162
Key Points

Question  Is health care for children in Australia consistent with quality standards?

Findings  In this study of 6689 Australian children aged 15 years and younger, a comparison of clinical records against quality indicators for 17 important child health conditions, such as asthma and type 1 diabetes, estimated that overall adherence was 59.8%, with substantial variation across conditions.

Meaning  For many important child health conditions, the quality of care in Australia may not be optimal.

Abstract

Importance  The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions.

Objective  To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings.

Design, Setting, and Participants  Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments.

Exposures  Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process.

Main Outcomes and Measures  Quality of care for each clinical condition and overall.

Results  Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury.

Conclusions and Relevance  Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate.

×