Abstract
The scope of low-value care in children's hospitals is poorly understood. To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services. This cross-sectional study developed and applied a calculator of hospital-based pediatric low-value care to estimate the prevalence and cost of low-value services among 1 011 950 encounters reported in 49 US children's hospitals contributing to the Pediatric Health Information System (PHIS) database. To develop the calculator, a multidisciplinary stakeholder group searched existing pediatric low-value care measures and used an iterative process to identify and operationalize relevant hospital-based measures in the PHIS database. Children with an eligible encounter in 2019 were included in the calculator-applied analysis. Two cohorts were analyzed: an emergency department cohort (with encounters resulting in emergency department discharge) and a hospitalized cohort. Eligible condition-specific hospital encounters. The proportion and volume of encounters in which low-value services were delivered and their associated standardized costs. Measures were ranked by those outcomes. There were 1 011 950 encounters eligible for 1 or more of 30 calculator-included measures in 2019; encounters were incurred by 816 098 unique patients with a median age of 3 years (IQR, 1-8 years). In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%]). In the hospitalized cohort, low-value care was most prevalent for broad-spectrum antibiotics in the treatment of community-acquired pneumonia (3406 of 5658 [60.2%]), acid suppression therapy for infants with esophageal reflux (3814 of 7507 of [50.8%]), and blood cultures for uncomplicated community-acquired pneumonia (2277 of 5823 [39.1%]). Measured low-value services generated nearly $17 million in total standardized cost. The costliest services in the emergency department cohort were computed tomography scan for abdominal pain (approximately $1.8 million) and minor head injury (approximately $1.5 million) and chest radiography for asthma (approximately $1.1 million). The costliest services in the hospitalized cohort were receipt of 2 or more concurrent antipsychotics (approximately $2.4 million), and chest radiography for bronchiolitis ($801 680) and asthma ($625 866). This cross-sectional analysis found that low-value care for some pediatric services was prevalent and costly. Measuring receipt of low-value services across conditions informs prioritization of deimplementation efforts. Continued use of this calculator may establish trends in low-value care delivery.
Highlights
Low-value care, or delivery of health services offering limited benefit as compared with harm, is an important domain of health care waste.[1,2,3] Consequences associated with such care range from physical effects, including adverse medication effects and procedural complications, to psychosocial and financial effects of incidental findings, false diagnoses, and downstream health care utilization
In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%])
Calculator for Pediatric Low-Value Care in US Children’s Hospitals. This cross-sectional analysis found that low-value care for some pediatric services was prevalent and costly
Summary
Low-value care, or delivery of health services offering limited benefit as compared with harm, is an important domain of health care waste.[1,2,3] Consequences associated with such care range from physical effects, including adverse medication effects and procedural complications, to psychosocial and financial effects of incidental findings, false diagnoses, and downstream health care utilization. Administrative databases containing billing information for a large number of encounters and offering accessible data for longitudinal measurement have emerged as sources for quantifying low-value care.[7,8,9] One proprietary tool measuring nearly 50 low-value services primarily delivered to adults has been applied to state- and payer-level data sets, identifying common and costly services and describing temporal low-value care trends.[7,9,10] Studies using administrative data have established low-value care as an important pediatric problem,[11,12,13,14,15] but most studies describe care at a single time point or for a limited set of measures. Tools leveraging large data sources for longitudinal measurement of low-value care and benchmark setting may prove valuable in scoping the issue
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