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To assess quality of ambulatory care in children, RAND investigators used a methodology that was developed for assessing care in adults and is based on medical records. They identified 175 quality indicators and reviewed charts (from 1996–2000) of 1536 randomly selected children from 12 metropolitan areas. The indicators were categorized by type of care (preventive care, chronic care, or acute infections), function of care, mode of care, and type of clinical indication.
Based on 22,000 assessments, overall adherence to quality indicators was poor (46%). Adherence rates were 41% for preventive care, 53% for chronic conditions, and 68% for acute conditions. Adherence rates, according to function of care, ranged from 38% for screening to 66% fo…