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Childhood Opportunity Index and Low-Value Care in Children's Hospitals
Irma T Ugalde1, Alan R Schroeder2, Jennifer R Marin3
1Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas.
Insights
Social drivers of health, measured by the Childhood Opportunity Index (COI), correlate with pediatric low-value care (LVC). Higher COI scores were linked to increased LVC likelihood, though absolute volumes were higher in lower COI areas.
Area of Science:
- Pediatric Healthcare Research
- Health Equity Studies
- Social Determinants of Health Analysis
Background:
- Limited research exists on the link between social drivers of health and low-value care (LVC) in pediatric populations.
- The Childhood Opportunity Index (COI) 2.0 is a measure of socioeconomic context that can reflect social drivers of health.
Purpose of the Study:
- To investigate the association between the Childhood Opportunity Index (COI) 2.0 and the prevalence of pediatric low-value care (LVC).
- To determine if children's hospital encounters in areas with different levels of opportunity exhibit varying rates of LVC.
Main Methods:
- Utilized the Pediatric Health Information System LVC Calculator for emergency and inpatient encounters from July 2021 to June 2022.
- Compared LVC proportions across the highest and lowest COI quintiles.
- Employed generalized estimating equation logistic regression to analyze LVC trends across COI quintiles.
Main Results:
- Analysis included 842,463 encounters across 20 LVC measures.
- The odds of LVC generally increased with higher COI quintiles (aOR 1.06).
- For 10 measures, LVC likelihood rose with increasing COI; gastric acid suppression in infants showed the strongest association (aOR 1.22).
- Conversely, 3 measures showed decreasing LVC with higher COI, with Group A streptococcal testing in young children having the lowest odds (aOR 0.85).
- The absolute volume of LVC was greater in lower COI quintiles for most measures.
Conclusions:
- The likelihood of pediatric low-value care (LVC) increased across higher Childhood Opportunity Index (COI) quintiles for a majority of measures studied.
- While likelihood varied, high absolute volumes of LVC were observed across all COI levels, indicating a need for broad de-implementation strategies.
- Prioritizing de-implementation efforts for measures disproportionately affecting children in lower opportunity areas is recommended.
Background And Objective:
Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals.
Methods:
We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles.
Results:
842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures.
Conclusions:
Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts.
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