The identification and subsequent prioritization of diseases and procedures with high practice variation is a critical step to inform subsequent prospective studies throughout all fields of medicine. We commend Cameron and colleagues1 for undertaking the formidable task of trying to create a prioritization framework for pediatric surgical conditions. The authors propose using 2 factors to “prioritize” conditions: (1) the magnitude of cost variation as a surrogate for the potential effect of comparative effectiveness research (CER) at the patient level and (2) the cumulative fiscal burden of the variation as a surrogate for the public health relevance of the condition. They conclude that high-priority conditions are those with high cost variation and high cumulative fiscal burden. Using this method, the authors determined that a few procedures accounted for most of the cost variation, and they recommend that gastroschisis, small intestinal atresia, appendicitis, and gastrostomy be targeted for future CER.1
Minneci PC, Deans KJ. Prioritizing Pediatric Surgical Conditions—A Call to Go Beyond Operations, Cost, and Comparative Effectiveness Research. JAMA Pediatr. 2017;171(2):e163923. doi:10.1001/jamapediatrics.2016.3923
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