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Trends in Low-Value Care Among Children's Hospitals.
House, Samantha A; Marin, Jennifer R; Coon, Eric R; Ralston, Shawn L; Hall, Matthew; Gruhler De Souza, Heidi; Ho, Timmy; Reyes, Mario; Schroeder, Alan R.
Affiliation
  • House SA; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, and New Hampshire Dartmouth Health Children's, Lebanon, New Hampshire.
  • Marin JR; UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
  • Coon ER; Department of Pediatrics, University of Utah, Salt Lake City, Utah.
  • Ralston SL; Department of Pediatrics, University of Washington, Seattle, Washington.
  • Hall M; Children's Hospital Association, Lenexa, Kansas.
  • Gruhler De Souza H; Children's Hospital Association, Lenexa, Kansas.
  • Ho T; Department of Neonatology, Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, Massachusetts.
  • Reyes M; Department of Pediatrics, Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida.
  • Schroeder AR; Department of Pediatrics, Stanford University, Stanford, California.
Pediatrics ; 153(1)2024 Jan 01.
Article in En | MEDLINE | ID: mdl-38130171
ABSTRACT
BACKGROUND AND

OBJECTIVES:

Longitudinal pediatric low-value care (LVC) trends are not well established. We used the Pediatric Health Information System LVC Calculator, which measures utilization of 30 nonevidenced-based services, to report 7-year LVC trends.

METHODS:

This retrospective cohort study applied the LVC Calculator to emergency department (ED) and hospital encounters from January 1, 2016, to December 31, 2022. We used generalized estimating equation models accounting for hospital clustering to assess temporal changes in LVC.

RESULTS:

There were 5 265 153 eligible ED encounters and 1 301 613 eligible hospitalizations. In 2022, of 21 LVC measures applicable to the ED cohort, the percentage of encounters with LVC had increased for 11 measures, decreased for 1, and remained unchanged for 9 as compared with 2016. Computed tomography for minor head injury had the largest increase (17%-23%; P < .001); bronchodilators for bronchiolitis decreased (22%-17%; P = .001). Of 26 hospitalization measures, LVC increased for 6 measures, decreased for 9, and was unchanged for 11. Inflammatory marker testing for pneumonia had the largest increase (23%-38%; P = .003); broad-spectrum antibiotic use for pneumonia had the largest decrease (60%-48%; P < .001). LVC remained unchanged or decreased for most medication and procedure measures, but remained unchanged or increased for most laboratory and imaging measures.

CONCLUSIONS:

LVC improved for a minority of services between 2016 and 2022. Trends were more favorable for therapeutic (medications and procedures) than diagnostic measures (imaging and laboratory studies). These data may inform prioritization of deimplementation efforts.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pneumonia / Low-Value Care Limits: Child / Humans Language: En Journal: Pediatrics Year: 2024 Type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pneumonia / Low-Value Care Limits: Child / Humans Language: En Journal: Pediatrics Year: 2024 Type: Article