Unwarranted variation in health care for children and young people

Abstract

The study of geographical variation in healthcare has moved on since J Allison Glover's seminal study in 1938, and its value in highlighting inequity in access, quality and outcomes is well-established. Study of variation in healthcare for children, however, has proven more difficult due to barriers with data and idiosyncrasies in how we measure outcomes for children and families. This paper is a narrative review of unwarranted variations in healthcare for children, and discusses the potential of variation analysis to help researchers and policy makers improve child health services.

Antibiotic and Diagnostic Discordance Between ED Physicians and Hospitalists for Pediatric Respiratory Illness

“…Perhaps most important are ED and hospitalist physicians' distinctive practice environments, contributing to specialty-specifi c preference-sensitive care variation, or different values, attitudes toward risk aversion, personal experience, and interpretation of evidence. 43 For example, the fewer opportunities in the ED to assess the patient and more pressure to arrive at a timely plan of treatment and disposition presumably infl uence ED physician decision-making relative to hospitalist decision-making. These environmental realities may contribute to different treatment thresholds.…”

An introduction to quality improvement in paediatrics and child health

“…Wolfe et al 's23 important study demonstrates significant variation in death rates in children and young people across Europe, highlighting that outcomes in the UK are relatively poor compared with other countries in Northern and Western Europe. Within the NHS, stark variation in indicators of quality and outcomes in healthcare for children can be seen 24. While inequity in health outcomes is quite rightly a policy priority, it is complex and multifactorial.…”

Using data to improve care

“…But persistent variation in the context of minimal differences in population factors highlights areas of ‘unwarranted variation’—variation which ‘cannot be explained by variation in patient illness or patient preferences’ 10. From a quality improvement perspective, it highlights inequitable healthcare provision and provides a starting point for services to benchmark their performance against peers, and to stimulate learning from higher-performing areas or services 11. Data on regional, national and international outcomes are published in many formats, using registry, audit and official statistics, and are a ready launch pad for many improvement initiatives 12–14…”