title: Variation in pediatric surgical care.
abstract: Variation in care and outcomes are common in the management of children with surgical diseases. Differences in the availability of resources, patient and family preferences, ever-increasing fiscal pressure, and lack of high-quality data to guide clinical decision making are just a few factors that contribute to both the over and under-utilization of healthcare resources. Identification of data-driven, value-based "best practices" that are sensitive to differences in resource availability and patient preferences may be an important first step in establishing a practical framework for reducing unwarranted practice variation. The goal of this article is to explore the causes and influence of practice variation using appendicitis as a common condition to illustrate key concepts, and to propose solutions to mitigate unwarranted practice variation while preserving the spirit of innovation necessary to advance the field.
authors.affiliation: Department of Surgery, Children׳s Hospital Boston, Harvard Medical School, 300 Longwood Ave, Fegan-3, Boston, Massachusetts 02115.
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Cameron
authors.affiliation: Department of Surgery, Children׳s Hospital Boston, Harvard Medical School, 300 Longwood Ave, Fegan-3, Boston, Massachusetts 02115. Electronic address: shawn.rangel@childrens.harvard.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
mesh_terms: D001062:Appendectomy / Q000592:standards*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D000066491:Clinical Decision-Making; D006300:Health Services Misuse / Q000517:prevention & control*; D054625:Healthcare Disparities; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D013043:Specialties, Surgical / Q000592:standards*; D014481:United States
keywords: Pediatric surgery; Practice variation; Resource utilization