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Value-Driven Care in Developmental-Behavioral Pediatrics, Part 1

The Value Proposition of Developmental-Behavioral Pediatrics

Sandler, Adrian D. MD

Journal of Developmental & Behavioral Pediatrics: July/August 2019 - Volume 40 - Issue 6 - p 472–478
doi: 10.1097/DBP.0000000000000685
Quality Matters

ABSTRACT: The drive to improve quality and reduce cost of health care is leading to a value-driven transformation of the US health care landscape. This is the first of a 2-part series on value-driven care and its implications for developmental-behavioral pediatrics (DBP). Tools derived from business/manufacturing models have been applied with some success to health care to better understand and enhance value. Value can be defined most simply as health outcomes achieved per dollar spent, but there are challenges in accounting for the full cost of a cycle or episode of care. When taking into account the “five Ds”—Development, Dependency, Differential Epidemiology, Demographics, and Dollars—the potential value of pediatric care is brought into sharper focus. The field of DBP in particular has the potential to add value through prevention, integration, efficiency, standardization, and innovation. The value proposition of DBP is illustrated by focusing on particular conditions or cycles of care commonly encountered in DBP practice: (1) children 0 to 3 years of age identified as having global developmental delay, (2) recent diagnosis of complex attention-deficit hyperactivity disorder (ADHD) (ADHD plus comorbid conditions), and (3) children with autism spectrum disorder and disruptive behavior. The second part of the series focuses on quality of care, emphasizing the important challenges that lie ahead for the field of DBP in measuring outcomes of care. With a discussion of national trends and a local example of a DBP program's response to these trends, the series is intended to provoke discussion and action in the field, contribute to the demonstration of value of a DBP approach to care, and help to chart a course toward growth and sustainability of DBP in an era of value-based care.

Department of Pediatrics, Olson Huff Center, Mission Children's Hospital, University of North Carolina at Chapel Hill, Asheville, NC.

Address for reprints: Adrian D. Sandler, MD, Olson Huff Center, 11 Vanderbilt Park Drive, Asheville, NC 28803; e-mail:

Disclosure: The author declares no conflict of interest.

Received December 21, 2018

Accepted April 02, 2019

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