PEDIATRICS Vol. 49 No. 4 April 1972, pp. 547-552
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EFFECTIVENESS OF PEDIATRIC CARE: THE RELATIONSHIP BETWEEN PROCESSES AND OUTCOME

Barbara Starfield M.D., M.P.H.1 and David Scheff M.D.1

1 Department of Pediatrics, The Johns Hopkins University School of Medicine and the School of Hygiene and Public Health (Department of Medical Care and Hospitals), The Johns Hopkins University, Baltimore, Maryland

The effectiveness of patient care was assessed by determining the adequacy of various steps in the care process and relating them to its outcome. Fifty-three children attending either of two university hospital clinics and having newly discovered low hemoglobins were randomly chosen. Review of medical records and home interviews showed that only 14 of the 53 low hemoglobin values were recognized, diagnosed, treated, and followed-up. In 39 children, the low hemoglobin value was unrecognized in 24, recognized but undiagnosed in six, diagnosed but untreated in one, and treated but not scheduled for follow-up in four; for four children the follow-up appointment was not kept. Mothers of 7 of the 22 children for whom treatment was prescribed denied receiving any therapy. Outcome in terms of eventual hemoglobin level was significantly related to the adequacy of the processes of care and especially to whether or not the patient received therapy. Major problems with record keeping also were apparent. The model used here is useful in evaluating the effectiveness of medical care because it relates specific activities of physicians, other health workers, and patients to outcome.

Submitted on July 12, 1971
Accepted on September 21, 1971




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