Reducing variability in patient care: Renewed focus for the pediatric cardiac surgeon in the twenty first century

The quest for the reduction of variability in the care of pediatric cardiac surgical patients began in the late twentieth century with the use of clinical pathways as a method of cost reduction, driven by pressures from managed care. In the early twenty first century, the emphasis has changed. It is now recognized that variability reduction is a quality issue - necessary to attain the outcomes demanded by an informed public. The development of heart centers built around a dedicated staff of health care providers concentrating on congenital heart disease is one way to attain the goal of reducing variability wherever possible, while providing excellence of care tailored to the individual patient. It is unclear what the resultant effect on cost will be. Implications for cost accounting and the impact on the academic model are discussed.