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Achievable Benchmarks of Care in Low-Value Care Delivery in Children's Hospitals
Alaina Shine1, Matt Hall2, Heidi G De Souza2
1Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle, Washington.
Insights
This study identified significant opportunities to reduce low-value care (LVC) in children's hospitals. By setting achievable benchmarks for care, hospitals can target specific areas for improvement and enhance patient outcomes.
Area of Science:
- Pediatric Healthcare Quality Improvement
- Health Services Research
- Clinical Performance Measurement
Background:
- Low-value care (LVC) represents a significant challenge in healthcare, contributing to increased costs and potential patient harm.
- Establishing objective targets is crucial for guiding quality improvement initiatives aimed at reducing LVC.
- Achievable benchmarks of care (ABCs) provide a data-driven approach to setting attainable goals for healthcare performance.
Purpose of the Study:
- To apply the Pediatric Health Information System (PHIS) low-value care (LVC) Calculator to identify variations in LVC across children's hospitals.
- To determine specific LVC measures with the greatest potential for improvement by calculating ABCs.
- To derive measure-level performance gaps and identify targets for deimplementation.
Main Methods:
- Utilized 16 LVC Calculator measures for hospitalized patients under 18 years old from PHIS data (July 2022-June 2024).
- Assessed LVC variation using interquartile ranges (IQRs) and calculated ABCs based on top-performing hospitals.
- Compared median hospital performance to ABCs to identify performance gaps and conducted quartile analysis for consistent performance trends.
Main Results:
- Analyzed 401,683 hospitalizations across 43 children's hospitals.
- Observed wide variation in LVC delivery, with ten measures showing performance gaps exceeding 10%.
- Identified substantial performance gaps for C-reactive protein/erythrocyte sedimentation rate in community-acquired pneumonia (39%), electrolyte testing in febrile seizures (38%), and blood cultures in community-acquired pneumonia (35%).
- Five measures had ABCs below 5%, indicating high potential for improvement.
- Quartile analysis revealed small groups of hospitals with consistently high or low LVC delivery.
Conclusions:
- Measurable improvement potential exists for several low-value services in pediatric care.
- The study provides measure-specific targets for deimplementation of LVC.
- Further investigation into high- and low-performing hospitals can elucidate drivers of LVC trends and inform best practices.
Objective:
Achievable benchmarks of care (ABCs) use performance data to derive objective and attainable targets for improvement initiatives. We applied the Pediatric Health Information System (PHIS) low-value care (LVC) Calculator to describe variation in LVC across hospitals and identify measures with the greatest potential for improvement.
Methods:
We applied the 16 LVC Calculator measures applicable to hospitalized patients younger than 18 years old to PHIS hospitalizations from July 1, 2022, to June 30, 2024. We used hospital-level data to assess LVC variation using IQRs and calculate ABCs, defined as the average performance attained by top-performing hospitals. We then compared median hospital-level performance to ABCs to derive measure-level performance gaps, signifying objective improvement potential. Finally, we performed a quartile analysis identifying hospitals with consistently high or low LVC delivery across measures.
Results:
A total of 401 683 hospitalizations at 43 children's hospitals were eligible for included measures. LVC delivery varied widely across hospitals for many measures. Ten measures demonstrated performance gaps of greater than 10%; the greatest performance gaps were observed for C-reactive protein and/or erythrocyte sedimentation rate for community-acquired pneumonia (39%), electrolyte testing in patients with febrile seizure (38%), and blood cultures in community-acquired pneumonia (35%). Five measures demonstrated ABCs of less than 5%. Quartile analyses demonstrated small cohorts of hospitals with consistently high or low performance across all measures.
Conclusions:
This analysis suggests measurable improvement potential for several low-value services and offers measure-specific deimplementation targets. Further study of high- and low-performing hospitals may identify hospital-level drivers of LVC trends.
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