The Hidden Value of Variation in Practice.

Abstract

* Abbreviations: CF — : cystic fibrosis CFF — : Cystic Fibrosis Foundation Although new disease modifying therapies offer promise, current management of cystic fibrosis (CF) lung disease is largely based on 2 strategies: first, decreasing the day-to-day burden of inflammation and mucus in the airways and, second, managing pulmonary exacerbations: acute episodes of increased symptoms thought to reflect periods of inflammation associated with bacterial infection. A mainstay of treating CF exacerbations has been using ≥1 intravenous antibiotics in the hospital accompanied by supportive measures, including intensified airway clearance. Investigators using the Epidemiologic Study of Cystic Fibrosis1 and the Cystic Fibrosis Foundation (CFF) Patient Registry2 have previously pointed out variation in CF care practices, particularly in therapies used for outpatient care. In this issue of Pediatrics , Cogen et al3 (“Characterization of Inpatient Cystic Fibrosis Pulmonary Exacerbations Using the Pediatric Health Information System Database”) use a novel data source from children’s hospitals to document surprising variation in many aspects of the inpatient management of CF exacerbations among 38 children’s hospitals participating in the CFF Care Center Network. Why is … Address correspondence to John T. McBride, MD, Department of Pediatrics, Akron Children’s Hospital, 2 Perkins Sq, Akron, Ohio 44308. E-mail: jtmcbride{at}gmail.com