Low-Value Emergency Care and Racial and Ethnic Differences Across US Children's Hospitals

Area of Science:

• Pediatric Emergency Medicine
• Health Equity
• Healthcare Disparities

Background:

• Low-value care (LVC) represents a significant concern in pediatric healthcare.
• Existing research suggests potential racial and ethnic disparities in healthcare delivery.

Purpose of the Study:

• To investigate racial and ethnic differences in LVC for common pediatric emergency conditions.
• To examine the relationship between hospital-level LVC rates and within-hospital disparities by race and ethnicity.

Main Methods:

• Cross-sectional study of over 314,000 pediatric emergency encounters (asthma, bronchiolitis, headache, minor head injury) from 2021-2023.
• Analysis of LVC rates by race and ethnicity (Black, White, Hispanic) using multivariable logistic regression.
• Examination of the association between hospital LVC rates and racial/ethnic LVC differences.

Main Results:

• Overall LVC rates varied by condition: asthma (18%), bronchiolitis (32%), headache (24%), minor head injury (26%).
• White patients had higher odds of receiving LVC compared to Black and Hispanic patients across multiple conditions.
• Hospital LVC rates were not associated with the magnitude of within-hospital LVC differences by race and ethnicity.

Conclusions:

• Lower hospital LVC rates did not correlate with reduced racial and ethnic disparities in LVC.
• Targeted strategies are essential to address and reduce LVC inequities in pediatric emergency care.