Can your address affect quality of care?

Where you live matters when it comes to the quality of medical services your child receives. According to a new report, whether children receive recommended care or endure potentially unnecessary treatments depends on where they live.

The Dartmouth Atlas Project’s report, published in December, examined pediatric hospital and outpatient care for children across Northern New England from 2007 to 2010. The report expands on a study done in the 1970s that found care that varied greatly for children with throat problems. The 1970s study caused doctors to find out why there was such large variation and reevaluate how they practiced, which resulted in less surgeries. This report revisits those same issues.

Overall, the new study found that children were more likely to end up in the emergency room (ER) in areas with less office visits where parents brought them in. Researchers also found that many Northern New England children are receiving unneeded care that exposes them to harmful side effects and burdens their families with unnecessary medical bills.

Children in Dover, N.H., for example, had nearly twice as many ER visits as children living in Burlington, Vt., the study revealed. Children in Lewiston, Maine, and Manchester, N.H., are 50 percent more likely to get CT scans of their head, exposing them to radiation, than children in Portland, Maine; Lebanon, N.H.; and Burlington, Vt., areas served by three major children’s hospitals.

Researchers found dramatic variation in outpatient physician services, hospitalizations, common surgeries, imaging and prescriptions. The study also examined how factors such as insurance coverage, income level and closeness to a major hospital or children’s hospital affect children’s health care.

“While there are many examples of excellent care for children, the inconsistency in care across a relatively small geographic region raises troubling questions about whether medical practice patterns reflect the care that infants and children need and that their families want or whether they are primarily the result of differences in physician and hospital practice styles,” said lead report author Dr. David Goodman in a statement. Goodman is professor of pediatrics at the Geisel School of Medicine at Dartmouth College in Hanover, N.H.