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February 6, 2017

Prioritizing Pediatric Surgical Conditions—A Call to Go Beyond Operations, Cost, and Comparative Effectiveness Research

Author Affiliations
  • 1Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
  • 2Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
JAMA Pediatr. 2017;171(2):e163923. doi:10.1001/jamapediatrics.2016.3923

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