Related Experiment Video
Updated: Jul 7, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Trends in Low-Value Care Among Children's Hospitals
Samantha A House1, Jennifer R Marin2, Eric R Coon3
1Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, and New Hampshire Dartmouth Health Children's, Lebanon, New Hampshire.
Insights
Pediatric low-value care (LVC) trends show improvement in only a few services. Therapeutic measures saw more favorable changes than diagnostic ones, indicating a need for targeted deimplementation efforts.
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.
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.
More Related Videos
Related Concept Videos
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:30Current Trends in Nursing II
01:28Hospitals-I
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
00:59Hospitals-II
Nurses that work in...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...