BALTIMORE — Five percent of children in one network of private primary care pediatric practices accounted for almost a third of pediatric subspecialty visits over a 2-year period, based on a study of more than 35,000 children.
Although roughly 60% of 35,487 pediatric primary care patients had no subspecialty visits between May 2006 and April 2008, 5% of children accounted for 32% of 40,487 subspecialty visits, Dr. Louis Vernacchio and his colleagues reported in a poster at the annual meeting of the Pediatric Academic Societies. The findings may soothe concerns about the overuse of subspecialists in the management of common conditions.
The researchers analyzed data on paid claims from a single large health plan for subspecialty visits for a 2-year period for all primary care patients (aged 0-20 years) of the Pediatric Physicians' Organization at Children's, which is a network of private primary care pediatric practices affiliated with Children's Hospital Boston. The network consists of 72 practices with 182 pediatricians. All visits to subspecialty physicians were included in the analysis, except for mental health visits, wrote Dr. Vernacchio, who is a member of one of those practices.
Patients were followed for a median of 14 months and were evenly split between the sexes (49% female). The top seven subspecialties—ophthalmology, orthopedic surgery, dermatology, otolaryngology, allergy and immunology, gastroenterology, and neurology—accounted for nearly three-quarters (72%) of all visits.
“Within subspecialties, there are common diagnoses/procedures which can be targets for primary care-based quality improvement or research initiatives aimed at enhancing primary care management and reducing unnecessary referrals,” the researchers noted. These include office vision screening, scoliosis screening and nonoperative management, acne management, and otitis media management.
The study was funded by internal funds of the Pediatric Physicians' Organization at Children's. The authors reported that they have no relevant disclosures.