Improving Pediatric Care: Evidence-Based Solutions to Support Better Member Outcomes

Pediatric patients are among the most vulnerable in society. Children rely on parents, family members, and sometimes state-appointed caregivers to ensure that they receive appropriate medical attention. For many pediatric conditions, determining when to seek care, as well as identifying the proper treatment and the most appropriate setting of care, can be challenging for payers, caregivers, and providers alike. In this article, we’ll explore the benefits of delivering evidence-based health care to infants, children, and adolescents, and we’ll also suggest how specific solutions can help all stakeholders improve pediatric care delivery across the entire patient journey.

Solutions to Support the Proper Level of Care: There are times when the default clinical judgment is to admit a child to the hospital “just to be safe,” whether or not the member’s condition warrants such an action. While the admitting physician may wish to use extra precautions by providing care in a more controlled environment to better monitor and administer treatment, hospital admission carries its own risks. Statistics show that hospital admission doesn’t always guarantee a safer environment. One study calculated that approximately 250,000 people die every year due to medical errors made during hospitalization. The authors concluded that, based on the available data, medical error was a leading cause of death.1

Using vetted clinical evidence based on the latest published research can help to determine proper levels of care. The MCG Health 22nd edition solutions offer over 100 pediatric-relevant Inpatient & Surgical Care guidelines (including guidance for neonatal levels of care, common medical diagnoses, and surgeries such as appendectomy and tonsillectomy) and over 500 pediatric-relevant Ambulatory Care guidelines for outpatient care. MCG Ambulatory Care content includes specific clinical guidance for durable medical equipment (e.g., continuous glucose monitors), genetic testing (e.g., CFTR genetic testing for cystic fibrosis), various high-cost imaging (e.g., PET scan, CT scan, MRI), and specialty medications (e.g., ivacaftor), among other areas. For post-acute care, MCG produces over 300 guidelines and patient information hand-outs to promote the most effective practices in chronic care and sustained disease management that can be done in recovery facilities or at home. Click here to watch a video on the Ambulatory Care solution.

Solutions to Support Reducing Unwarranted Clinical Variation: Variation in delivered care is not limited to pediatric members; however, significant aberrations may be found in this population. In 2016, a study looked at the hospital records of 49,000 children hospitalized for asthma at 37 major U.S. nonprofit children’s hospitals using the Pediatric Health Information System dataset. The researchers discovered that even if pediatric patients were grouped by similar characteristics, such as age or severity of illness, the inpatient costs, length of stay (LOS), and time spent in the ICU varied greatly. When the lower eighth of hospitals was compared with the upper eighth, the median hospital costs varied by 87%, total LOS varied by 47%, and ICU use was 254% higher.2  MCG Benchmarks and Data, as well as Cite Guideline Analytics (our solution co-developed with Milliman MedInsight), can give healthcare professionals an understanding of regional benchmarks and help them to identify areas in which their utilization may deviate from that of well-managed populations. Click here to watch a video on how MCG Benchmarks and Data facilitate a data-driven conversation between payers and providers, or watch our on-demand webinar on Cite Guideline Analytics.

Solutions to Support Reduction of Pediatric Substance Abuse:

High-quality care is also important in addressing youth substance use disorders. In 2015, only 30% of substance abuse programs were specifically designed to address the issues of adolescent patients.3 The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 1.3 million U.S. adolescents from age 12 to 17 years had a substance use disorder in 2014.4 The cost of substance abuse - much of which begins in adolescence - to federal, state, and local governments is at least $468 billion per year.5

MCG Behavioral Health Care guidelines can support pediatric care with evidence-based interventions that comply with mental health parity law. MCG content also aligns with and expands upon the nationally recognized ASAM criteria and is equipped with content and tools that address topics related to chronic opioid use, such as medication-assisted opioid withdrawal, dependency risk, and more. Watch this video to learn more.

To address the challenges facing pediatric health care delivery, MCG equips payers with a strong evidence base and interactive software to support clinically effective pediatric care and to facilitate its provision in the most appropriate setting. Click here to learn more about the extensive portfolio of solutions MCG offers to payer organizations.

Primary image courtesy Shutterstock/A3pfamily


  1. Study suggests medical errors now third leading cause of death in the U.S. [Internet] John Hopkins Medicine. Accessed at: https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us. Updated 2016 May 03. [accessed 2018 Jun 13]
  2. Silber JH, et al. Auditing practice style variation in pediatric inpatient asthma care. JAMA Pediatrics 2016;170(9):878-86.
  3. Cacciola JS, Meyers K, Bates SE, Rosenwasser B, Arria A, McLellan AT. Assessing adolescent substance abuse programs with updated quality indicators: the development of a consumer guide for adolescent treatment. Journal of Child and Adolescent Substance Abuse 2015;24(3):142-54.
  4. Age- and gender-based populations. [Internet] Substance Abuse and Mental Health Services Administration. 2018 Jan 17. Accessed at: https://www.samhsa.gov/specific-populations/age-gender-based [accessed 2018 Jun 9]
  5. Adolescent substance use: American’s #1 public health problem. [Internet] Center on Addiction. 2011 June. Accessed at: https://www.centeronaddiction.org/addiction-research/reports/adolescent-substance-use-america%E2%80%99s-1-public-health-problem. [accessed 2018 Jun 9]

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