New study: Smart Start children more likely to have health care

November 29, 2000

CHAPEL HILL -- North Carolina children who attended child care centers that participate in Smart Start quality improvement activities were more likely to have a regular source of health care than children who did not attend such centers, a new University of North Carolina at Chapel Hill study shows.

Ninety percent of children at participating Smart Start centers had a regular source of health care versus 82 percent of children who attended other centers, said Dr. Jonathan B. Kotch, professor of maternal and child health at the UNC-CH School of Public Health. "These preliminary findings of regular access to health care for children attending certain Smart Start centers are encouraging," said Kotch, who directed the study.

The study, conducted by the university's Frank Porter Graham Child Development Center, involved 213 children in a Smart Start group and 290 children in a non-Smart Start group. Six Smart Start partnerships around North Carolina participated in the study.

"The results show that increased access to regular health care for children is associated with attendance at child care centers that participate in Smart Start quality improvement activities," Kotch said. "While these activities were not intended directly to affect access to health services, it appears they did, or that they are associated with a factor that we didn't measure.

"However it is achieved, any reduction in using the emergency room represents a significant cost savings," he said. "For example, a typical emergency room visit for a Medicaid-eligible child with an acute ear infection costs more than 15 percent more than a typical office visit does."

Improvements to the quality of care at the Smart Start centers included:The positive effect of Smart Start quality improvement activities was the same across racial and economic lines. Children who enter public kindergarten in North Carolina must have a health-care professional complete a Kindergarten Health Assessment form, Kotch said. Data for the study was collected from these forms. "We combined the categories for private doctor, health maintenance organization, public health department and community health center into the 'regular care' category," he said. "We also combined the categories for emergency room, hospital clinic, none and 'other' into the 'no regular care' category," he said.

The study focused on only those Smart Start centers with improvements to quality-of-care activities, not Smart Start centers with specific health intervention activities. However, data is being collected for a larger study that focuses specifically on children who participated in Smart State health interventions, he said.
More information about Smart Start is available at or by calling (919) 821-7999. The Division of Child Development of the N.C. Department of Health and Human Services funded the study.

Note: Kotch can be reached at (919) 966-5976 or via e-mail at

Graham Center contact: Loyd Little, 966-0867, or
School of Public Health contact: Lisa Katz, 966-7467, or
News Services contact: David Williamson, 962-8596 or

University of North Carolina at Chapel Hill

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