Evidence-based health care for children: what are we missing?

With the enactment of comprehensive health reform, reimbursement for a variety of health care services will likely depend on evidence to support that provision. Understanding what constitutes "evidence" will have a profound effect on the range of clinical care provided. A too-narrow definition may have a considerable impact on pediatric care in particular: much of current child health care requires consideration of a broader body of evidence than is usually relied upon when developing clinical guidelines. This is especially true for care that addresses behavioral and developmental problems. The current standard for evaluating evidence uses study design as a proxy for the quality of evidence; it may therefore inadvertently exclude many important findings and fail to support further relevant research. The project described here yielded a new, broader framework for evaluating clinical practice, one that should be of value to both clinicians and policymakers.