Trends in Low-Value Care Among Children's Hospitals

Area of Science:

• Pediatric healthcare quality and utilization
• Health services research
• Evidence-based medicine in pediatrics

Background:

• Longitudinal trends in pediatric low-value care (LVC) are not well-established.
• The study utilized the Pediatric Health Information System LVC Calculator to assess 30 non-evidenced-based services.
• A 7-year period was analyzed to understand LVC trends.

Purpose of the Study:

• To report 7-year trends in pediatric low-value care (LVC).
• To analyze changes in the utilization of non-evidenced-based services in pediatric emergency departments and hospitalizations.
• To identify specific areas where LVC has increased or decreased over time.

Main Methods:

• A retrospective cohort study design was employed.
• The Pediatric Health Information System LVC Calculator was applied to emergency department (ED) and hospital encounters from 2016 to 2022.
• Generalized estimating equation models were used to assess temporal changes in LVC, accounting for hospital clustering.

Main Results:

• In 2022, LVC increased for 11 of 21 applicable ED measures (e.g., CT for minor head injury) and decreased for 1 (bronchodilators for bronchiolitis).
• For hospitalizations, LVC increased for 6 of 26 measures (e.g., inflammatory marker testing for pneumonia) and decreased for 9 (e.g., broad-spectrum antibiotics for pneumonia).
• LVC trends were more favorable for medications and procedures compared to laboratory and imaging measures.

Conclusions:

• Pediatric low-value care (LVC) improved for a minority of services between 2016 and 2022.
• Trends in LVC were more positive for therapeutic interventions (medications, procedures) than for diagnostic measures (imaging, laboratory tests).
• Findings can guide the prioritization of deimplementation strategies for low-value care in pediatrics.