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IMPORTANCE The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. OBJECTIVE To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. DESIGN, SETTING, AND PARTICIPANTS Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4] , acute infection [n = 7], and injury [n = 1] ), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. EXPOSURES Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. MAIN OUTCOMES AND MEASURES Quality of care for each clinical condition and overall. RESULTS Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. CONCLUSIONS AND RELEVANCE Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate. Refereed/Peer-reviewed

Due to rising demand for sleep services, there has been growing interest in ambulatory models of care for obstructive sleep apnea (OSA). With appropriate training and simplified management tools, primary care physicians (PCPs) are ideally positioned to take on a greater role in the diagnosis and treatment of OSA. Objective: To compare the clinical efficacy and cost-effectiveness of a simplified model of diagnosis and care for OSA in primary care relative to that in specialist sleep centres. Design: A randomised, controlled, non-inferiority study. Setting: Primary care practices in metropolitan Adelaide and 3 rural regions of South Australia and a university hospital sleep medicine centre in Adelaide, Australia. Patients: A total of 155 patients with OSA (identified by screening questionnaire and home oximetry) and Epworth Sleepiness Scale (ESS) ≥8 or resistant hypertension were randomised into the study between September 2008 to June 2010. 81 patients were randomly assigned to the primary care arm and 74 patients to the specialist arm., The study was funded by the National Health and Medical Research Council of Australia (Project Grant 426744) and a small grant from the Flinders Medical Centre Foundation. Research scholarship support was provided to Dr Chai-Coetzer by the Flinders Medical Centre Clinicians Trust. Equipment donations were received from ResMed (ApneaLink oximetry monitors and CPAP machines), Philips Respironics (CPAP machines) and SomnoMed (mandibular advancement splints).