Children with complex medical needs get very different treatment depending on where in Northern New England they receive care. That’s the conclusion of a new study by The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth’s Geisel School of Medicine.
It was published online on Oct. 5 in Pediatrics, the official journal of the American Academy of Pediatrics.
Children with chronic diseases or serious conditions are thankfully rare, but they account for 40 percent of pediatric hospital charges.
The researchers wanted to see how much treatment varies across Vermont, New Hampshire and Maine hospitals. Co-author Shawn Ralston, at Dartmouth’s Geisel Medical School, says most young patients receive similar basic tests, like chest X-rays.
“But we saw much more variation in the use of things that might be more discretionary, like MRI of the head,” Ralston says.
Such invasive tests, she says, are not always warranted, and can be risky.
There is no way to tell from this data whether children benefited from less, or more medical intervention.
"This is a different patient population and there should be some variation in there. But there shouldn't be variation at the level we are seeing." - Shawn Ralston, Geisel School of Medicine
The study does find variations that Ralston thinks may have as much to do with the “medical culture” of a hospital, as with proper standards of care.
”This is a different patient population and there should be some variation in there but there shouldn’t be variation at the level we are seeing,” Ralston says.
Ralston and her co-authors hope the study will prompt thinking about standardizing best practices for New England's sickest children.
