Medical Practice Variations in Pediatric Care

Abstract

The study of pediatric medical practice variation began with reports on tonsillectomy rates in children almost a century ago. However, the majority of studies have only been conducted in the past two decades. The study of variations is important in revealing problems with healthcare systems and practice, and can be used to improve processes and outcomes in the care of children. However, there are some key issues that have hindered growth in pediatric variation studies, such as matters related to the ecology of disease and healthcare use unique to children, the paucity of evidence-based care, the relative lack of child health services capacity and population-based data, and other issues related to child health research in general (the four “D”s, which include Differential epidemiology, Developmental change, Dependency, and Demographics). This chapter examines methodological issues in child health and health services research that have challenged the study of pediatric practice variations, and examines variations in terms of effective care, preference-based care, and supply-sensitive care as it pertains to primary care and hospital care of children. Consideration of how variations studies and pediatric care networks are using variations work and benchmarking to drive quality improvement efforts will be discussed. This chapter ends with an exploration of future directions in the pediatric field of medical practice variations.