Racial and ethnic differences in low-value pediatric emergency care

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Health Equity

Background:

• Health care quality disparities often involve underuse of services.
• This study investigated racial and ethnic differences in the delivery of low-value services within pediatric emergency departments (EDs).

Purpose of the Study:

• To evaluate racial and ethnic variations in the utilization of 12 specific low-value services across nine common pediatric conditions.
• To identify if race and ethnicity are associated with receiving potentially unnecessary medical interventions in pediatric EDs.

Main Methods:

• A retrospective cross-sectional study analyzed data from 4,676,802 children discharged from 39 pediatric EDs between January 2018 and December 2019.
• Low-value services included specific imaging, laboratory tests, and medications for conditions like asthma, bronchiolitis, febrile seizures, and head injuries.
• Generalized linear mixed models were used to assess the association of race/ethnicity with low-value service receipt, adjusting for multiple demographic and clinical factors.

Main Results:

• Non-Hispanic White (NHW) patients had higher odds of receiving low-value imaging for asthma, bronchiolitis, head injury, headache, and constipation compared to Non-Hispanic Black (NHB) and Hispanic patients.
• NHB patients had higher odds of receiving low-value steroids and beta-agonists for bronchiolitis compared to NHW patients.
• Racial and ethnic minorities showed varied patterns of receiving low-value services, with some groups receiving less imaging and others receiving more medication.

Conclusions:

• Significant racial and ethnic disparities were observed in the receipt of low-value services in pediatric EDs.
• NHW children were more likely to receive low-value imaging, whereas NHB children were more likely to receive low-value medications for bronchiolitis.
• These findings underscore the complex interplay of race, ethnicity, and clinical practice, necessitating further investigation into the drivers of these disparities.