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April 2015

Establishing Superior Benchmarks of Care in Clinical PracticeA Proposal to Drive Achievable Health Care Value

Author Affiliations
  • 1Department of Pediatrics, Children’s National Health System, The George Washington School of Medicine, Washington, DC
  • 2Center for Program Integrity, Centers for Medicare and Medicaid Services, Washington, DC
JAMA Pediatr. 2015;169(4):301-302. doi:10.1001/jamapediatrics.2014.3580

Value-driven care is a central theme across medicine in the current era of health care reform. Numerous factors are working to decrease unwarranted variability in care that drives up costs without adding value. For example, asthma, bronchiolitis, and pneumonia are leading causes of pediatric admissions with good data available to inform optimal management, and despite this, tremendous variation of care has been well documented.1 Clinical practice guidelines (CPGs), systematically developed statements that guide decision making, are intended to streamline care and reduce unwarranted variation. It is not surprising that major national organizations such as the American Academy of Pediatrics, the National Heart, Lung, and Blood Institute, and the Infectious Diseases Society of America have developed evidence- and consensus-based CPGs for the management of bronchiolitis, asthma, and pneumonia, respectively.24 What may be surprising is that, despite the availability of national CPGs for several years for these conditions, wide variation in their management persists across hospitals in the United States, leading to excess resource utilization and cost of care.1

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