Interspecialty Differences in the Care of Children with Chronic or Serious Acute Conditions: A Review of the Literature

Little is known about the specific roles of pediatric subspecialists and other physician providers, such as general specialists, internist subspecialists, and general pediatricians, in the care of children in the United States. The involvement of various types of providers in the care of children with chronic or serious acute conditions raises concerns about interspecialty differences in quality. Many studies of adult populations have demonstrated interspecialty differences in care for various conditions. These studies generally found that specialists are more knowledgeable than generalists for specific conditions, adhere more closely to current recommendations and guidelines, and have better condition-specific outcomes. Others found that generalists have better knowledge of immunization recommendations,⁸ similar outcomes and patient satisfaction levels, and lower costs.¹⁰ Systematic reviews have identified persistent interspecialty differences in knowledge, patterns of care, costs, and outcomes for a wide variety of chronic conditions affecting adult patients. To explore these issues, we conducted a review to determine what is currently known about interspecialty differences in the care of children and the quality of the existing literature.

Abbreviations: MeSH, Medical Subject Heading