Journal of Pediatric Urology (2014) 10, 706
EDITORIAL
Population and Health Services Research The Population and Health Services Research section of this issue of the Journal include several articles that highlight the promise and challenge of this type of research. Cohen et al. and Chu et al. both use large administrative databases to investigate patterns of care in pediatric renal surgery. Although the specific aims of their studies are different, they both seek to characterize utilization of various surgical approaches to renal surgery (total versus nephron-sparing surgery in the case of Chu et al., and open vs. minimally-invasive surgery in the case of Cohen). Such research gives us a snapshot of trends in care within a certain region or (in the case the Chu paper) nationally. These articles also demonstrate the limitations of administrative datasets; they offer us limited explanatory power as the data is not granular enough to truly explain some of the associations observed. Contrary to what some would argue, these limitations do not invalidate secondary data research or mean that we should not conduct such studies. However, we must remain aware of context and understand how the findings fit into the larger picture of contemporary pediatric urological care. Arlen et al. report interesting findings from a single institution demonstrating the relative infrequency of readmission after pediatric urological surgery. As Kathy Herbst notes in her thoughtful commentary, these results make clear that using 30-day readmission rates as a
measure of quality of care may not be a fruitful approach for quality improvement, at least in pediatric urology. Finally, I would like to particularly highlight the paper by Jean Hollowell and colleagues. A large majority of published health services research is descriptive in nature; identifying issues with quality of healthcare. Such studies, while essential, do not directly provide much guidance for how to actually fix the quality problem being studies. Hollowell et al. sought to go a step further, and actually conduct an intervention seeking to rectify a quality issue previously identified; in this case, the excessive use of ultrasound in patients with cryptorchidism. While their study has acknowledged flaws, the important take-home point is that we can DO SOMETHING about quality deficiencies in healthcare. Not every problem is amenable to interventions by pediatric urologists, but at least some are. Hollowell et al. show us that we can effect positive change, with benefits for both our patients and the healthcare system. C. Nelson Boston Children’s Hospital, Department of Urology, 300 Longwood Avenue, HU-359, Boston, MA 02115, United States E-mail address: [email protected]
http://dx.doi.org/10.1016/j.jpurol.2014.08.001 1477-5131/ª 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
EDITORIAL
Population and Health Services Research The Population and Health Services Research section of this issue of the Journal include several articles that highlight the promise and challenge of this type of research. Cohen et al. and Chu et al. both use large administrative databases to investigate patterns of care in pediatric renal surgery. Although the specific aims of their studies are different, they both seek to characterize utilization of various surgical approaches to renal surgery (total versus nephron-sparing surgery in the case of Chu et al., and open vs. minimally-invasive surgery in the case of Cohen). Such research gives us a snapshot of trends in care within a certain region or (in the case the Chu paper) nationally. These articles also demonstrate the limitations of administrative datasets; they offer us limited explanatory power as the data is not granular enough to truly explain some of the associations observed. Contrary to what some would argue, these limitations do not invalidate secondary data research or mean that we should not conduct such studies. However, we must remain aware of context and understand how the findings fit into the larger picture of contemporary pediatric urological care. Arlen et al. report interesting findings from a single institution demonstrating the relative infrequency of readmission after pediatric urological surgery. As Kathy Herbst notes in her thoughtful commentary, these results make clear that using 30-day readmission rates as a
measure of quality of care may not be a fruitful approach for quality improvement, at least in pediatric urology. Finally, I would like to particularly highlight the paper by Jean Hollowell and colleagues. A large majority of published health services research is descriptive in nature; identifying issues with quality of healthcare. Such studies, while essential, do not directly provide much guidance for how to actually fix the quality problem being studies. Hollowell et al. sought to go a step further, and actually conduct an intervention seeking to rectify a quality issue previously identified; in this case, the excessive use of ultrasound in patients with cryptorchidism. While their study has acknowledged flaws, the important take-home point is that we can DO SOMETHING about quality deficiencies in healthcare. Not every problem is amenable to interventions by pediatric urologists, but at least some are. Hollowell et al. show us that we can effect positive change, with benefits for both our patients and the healthcare system. C. Nelson Boston Children’s Hospital, Department of Urology, 300 Longwood Avenue, HU-359, Boston, MA 02115, United States E-mail address: [email protected]
http://dx.doi.org/10.1016/j.jpurol.2014.08.001 1477-5131/ª 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
![[Health services research is a service to the population health].](/assets/img/hold.png)
