Development and Use of a Calculator to Measure Pediatric Low-Value Care Delivered in US Children's Hospitals
The scope of low-value care in children's hospitals is poorly understood. To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services. This cross-sectional study developed and applied a calculator of hospital-based pediatric...
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| Veröffentlicht in: | JAMA network open 2021-12, Vol.4 (12), p.e2135184 |
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| creator | House, Samantha A Hall, Matthew Ralston, Shawn L Marin, Jennifer R Coon, Eric R Schroeder, Alan R De Souza, Heidi Gruhler Davidson, Amber Duda, Patti Ho, Timmy Genies, Marquita C Mestre, Marcos Reyes, Mario A |
| description | The scope of low-value care in children's hospitals is poorly understood.
To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services.
This cross-sectional study developed and applied a calculator of hospital-based pediatric low-value care to estimate the prevalence and cost of low-value services among 1 011 950 encounters reported in 49 US children's hospitals contributing to the Pediatric Health Information System (PHIS) database. To develop the calculator, a multidisciplinary stakeholder group searched existing pediatric low-value care measures and used an iterative process to identify and operationalize relevant hospital-based measures in the PHIS database. Children with an eligible encounter in 2019 were included in the calculator-applied analysis. Two cohorts were analyzed: an emergency department cohort (with encounters resulting in emergency department discharge) and a hospitalized cohort.
Eligible condition-specific hospital encounters.
The proportion and volume of encounters in which low-value services were delivered and their associated standardized costs. Measures were ranked by those outcomes.
There were 1 011 950 encounters eligible for 1 or more of 30 calculator-included measures in 2019; encounters were incurred by 816 098 unique patients with a median age of 3 years (IQR, 1-8 years). In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%]). In the hospitalized cohort, low-value care was most prevalent for broad-spectrum antibiotics in the treatment of community-acquired pneumonia (3406 of 5658 [60.2%]), acid suppression therapy for infants with esophageal reflux (3814 of 7507 of [50.8%]), and blood cultures for uncomplicated community-acquired pneumonia (2277 of 5823 [39.1%]). Measured low-value services generated nearly $17 million in total standardized cost. The costliest services in the emergency department cohort were computed tomography scan for abdominal pain (approximately $1.8 million) and minor head injury (approximately $1.5 million) and chest radiography for asthma (approximately $1.1 million). The costliest services in the hospitalized cohort were receip |
| doi_str_mv | 10.1001/jamanetworkopen.2021.35184 |
| format | Article |
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To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services.
This cross-sectional study developed and applied a calculator of hospital-based pediatric low-value care to estimate the prevalence and cost of low-value services among 1 011 950 encounters reported in 49 US children's hospitals contributing to the Pediatric Health Information System (PHIS) database. To develop the calculator, a multidisciplinary stakeholder group searched existing pediatric low-value care measures and used an iterative process to identify and operationalize relevant hospital-based measures in the PHIS database. Children with an eligible encounter in 2019 were included in the calculator-applied analysis. Two cohorts were analyzed: an emergency department cohort (with encounters resulting in emergency department discharge) and a hospitalized cohort.
Eligible condition-specific hospital encounters.
The proportion and volume of encounters in which low-value services were delivered and their associated standardized costs. Measures were ranked by those outcomes.
There were 1 011 950 encounters eligible for 1 or more of 30 calculator-included measures in 2019; encounters were incurred by 816 098 unique patients with a median age of 3 years (IQR, 1-8 years). In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%]). In the hospitalized cohort, low-value care was most prevalent for broad-spectrum antibiotics in the treatment of community-acquired pneumonia (3406 of 5658 [60.2%]), acid suppression therapy for infants with esophageal reflux (3814 of 7507 of [50.8%]), and blood cultures for uncomplicated community-acquired pneumonia (2277 of 5823 [39.1%]). Measured low-value services generated nearly $17 million in total standardized cost. The costliest services in the emergency department cohort were computed tomography scan for abdominal pain (approximately $1.8 million) and minor head injury (approximately $1.5 million) and chest radiography for asthma (approximately $1.1 million). The costliest services in the hospitalized cohort were receipt of 2 or more concurrent antipsychotics (approximately $2.4 million), and chest radiography for bronchiolitis ($801 680) and asthma ($625 866).
This cross-sectional analysis found that low-value care for some pediatric services was prevalent and costly. Measuring receipt of low-value services across conditions informs prioritization of deimplementation efforts. Continued use of this calculator may establish trends in low-value care delivery.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.35184</identifier><identifier>PMID: 34967884</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Asthma ; Bronchiolitis - epidemiology ; Bronchiolitis - therapy ; Bronchodilators ; Child ; Child, Hospitalized ; Child, Preschool ; Craniocerebral Trauma - epidemiology ; Craniocerebral Trauma - therapy ; Cross-Sectional Studies ; Databases, Factual ; Head injuries ; Health Care Costs ; Hospitalization ; Hospitals, Pediatric - statistics & numerical data ; Humans ; Infant ; Low-Value Care ; Male ; Online Only ; Original Investigation ; Pediatrics ; Pharyngitis - epidemiology ; Pharyngitis - therapy ; Pneumonia ; Prevalence ; Tomography ; United States - epidemiology</subject><ispartof>JAMA network open, 2021-12, Vol.4 (12), p.e2135184</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2021 House SA et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a473t-75ce61b9a81c2b037f87610dcedc1b1a1180d8a7ba7a49f911be78ab11ce87633</citedby><cites>FETCH-LOGICAL-a473t-75ce61b9a81c2b037f87610dcedc1b1a1180d8a7ba7a49f911be78ab11ce87633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34967884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>House, Samantha A</creatorcontrib><creatorcontrib>Hall, Matthew</creatorcontrib><creatorcontrib>Ralston, Shawn L</creatorcontrib><creatorcontrib>Marin, Jennifer R</creatorcontrib><creatorcontrib>Coon, Eric R</creatorcontrib><creatorcontrib>Schroeder, Alan R</creatorcontrib><creatorcontrib>De Souza, Heidi Gruhler</creatorcontrib><creatorcontrib>Davidson, Amber</creatorcontrib><creatorcontrib>Duda, Patti</creatorcontrib><creatorcontrib>Ho, Timmy</creatorcontrib><creatorcontrib>Genies, Marquita C</creatorcontrib><creatorcontrib>Mestre, Marcos</creatorcontrib><creatorcontrib>Reyes, Mario A</creatorcontrib><title>Development and Use of a Calculator to Measure Pediatric Low-Value Care Delivered in US Children's Hospitals</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>The scope of low-value care in children's hospitals is poorly understood.
To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services.
This cross-sectional study developed and applied a calculator of hospital-based pediatric low-value care to estimate the prevalence and cost of low-value services among 1 011 950 encounters reported in 49 US children's hospitals contributing to the Pediatric Health Information System (PHIS) database. To develop the calculator, a multidisciplinary stakeholder group searched existing pediatric low-value care measures and used an iterative process to identify and operationalize relevant hospital-based measures in the PHIS database. Children with an eligible encounter in 2019 were included in the calculator-applied analysis. Two cohorts were analyzed: an emergency department cohort (with encounters resulting in emergency department discharge) and a hospitalized cohort.
Eligible condition-specific hospital encounters.
The proportion and volume of encounters in which low-value services were delivered and their associated standardized costs. Measures were ranked by those outcomes.
There were 1 011 950 encounters eligible for 1 or more of 30 calculator-included measures in 2019; encounters were incurred by 816 098 unique patients with a median age of 3 years (IQR, 1-8 years). In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%]). In the hospitalized cohort, low-value care was most prevalent for broad-spectrum antibiotics in the treatment of community-acquired pneumonia (3406 of 5658 [60.2%]), acid suppression therapy for infants with esophageal reflux (3814 of 7507 of [50.8%]), and blood cultures for uncomplicated community-acquired pneumonia (2277 of 5823 [39.1%]). Measured low-value services generated nearly $17 million in total standardized cost. The costliest services in the emergency department cohort were computed tomography scan for abdominal pain (approximately $1.8 million) and minor head injury (approximately $1.5 million) and chest radiography for asthma (approximately $1.1 million). The costliest services in the hospitalized cohort were receipt of 2 or more concurrent antipsychotics (approximately $2.4 million), and chest radiography for bronchiolitis ($801 680) and asthma ($625 866).
This cross-sectional analysis found that low-value care for some pediatric services was prevalent and costly. Measuring receipt of low-value services across conditions informs prioritization of deimplementation efforts. Continued use of this calculator may establish trends in low-value care delivery.</description><subject>Asthma</subject><subject>Bronchiolitis - epidemiology</subject><subject>Bronchiolitis - therapy</subject><subject>Bronchodilators</subject><subject>Child</subject><subject>Child, Hospitalized</subject><subject>Child, Preschool</subject><subject>Craniocerebral Trauma - epidemiology</subject><subject>Craniocerebral Trauma - therapy</subject><subject>Cross-Sectional Studies</subject><subject>Databases, Factual</subject><subject>Head injuries</subject><subject>Health Care Costs</subject><subject>Hospitalization</subject><subject>Hospitals, Pediatric - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Low-Value Care</subject><subject>Male</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pediatrics</subject><subject>Pharyngitis - epidemiology</subject><subject>Pharyngitis - therapy</subject><subject>Pneumonia</subject><subject>Prevalence</subject><subject>Tomography</subject><subject>United States - epidemiology</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkUFv1DAQhSMEolXpX0AWHOCSxRMnscMBCW2hRVoEEixXa-JMqBcnDnayFf8eb1uq0tNYmu89-c3LshfAV8A5vNnhgCPNVz788hONq4IXsBIVqPJRdlxUssyF4tXje--j7DTGHee84CCaunqaHYmyqaVS5XHmzmhPzk8DjTPDsWPbSMz3DNkanVkczj6w2bPPhHEJxL5SZ3EO1rCNv8p_oFsokWlxRs7uKVDH7Mi239j60rou0PgqsgsfJzuji8-yJ30adHo7T7Ltxw_f1xf55sv5p_X7TY6lFHMuK0M1tA0qMEXLheyVrIF3hjoDLSCA4p1C2aLEsukbgJakwhbAUCKFOMne3fhOSzskUcoW0Okp2AHDH-3R6v83o73UP_1eKwlNIepk8PrWIPjfC8VZDzYaci6d3i9RFzVUpay5OqAvH6A7v4QxxUtULaUsoKgS9faGMsHHGKi_-wxwfehVP-hVH3rV170m8fP7ce6k_1oUfwFFmKS8</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>House, Samantha A</creator><creator>Hall, Matthew</creator><creator>Ralston, Shawn L</creator><creator>Marin, Jennifer R</creator><creator>Coon, Eric R</creator><creator>Schroeder, Alan R</creator><creator>De Souza, Heidi Gruhler</creator><creator>Davidson, Amber</creator><creator>Duda, Patti</creator><creator>Ho, Timmy</creator><creator>Genies, Marquita C</creator><creator>Mestre, Marcos</creator><creator>Reyes, Mario A</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20211201</creationdate><title>Development and Use of a Calculator to Measure Pediatric Low-Value Care Delivered in US Children's Hospitals</title><author>House, Samantha A ; Hall, Matthew ; Ralston, Shawn L ; Marin, Jennifer R ; Coon, Eric R ; Schroeder, Alan R ; De Souza, Heidi Gruhler ; Davidson, Amber ; Duda, Patti ; Ho, Timmy ; Genies, Marquita C ; Mestre, Marcos ; Reyes, Mario A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a473t-75ce61b9a81c2b037f87610dcedc1b1a1180d8a7ba7a49f911be78ab11ce87633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Asthma</topic><topic>Bronchiolitis - epidemiology</topic><topic>Bronchiolitis - therapy</topic><topic>Bronchodilators</topic><topic>Child</topic><topic>Child, Hospitalized</topic><topic>Child, Preschool</topic><topic>Craniocerebral Trauma - epidemiology</topic><topic>Craniocerebral Trauma - therapy</topic><topic>Cross-Sectional Studies</topic><topic>Databases, Factual</topic><topic>Head injuries</topic><topic>Health Care Costs</topic><topic>Hospitalization</topic><topic>Hospitals, Pediatric - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Low-Value Care</topic><topic>Male</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Pediatrics</topic><topic>Pharyngitis - epidemiology</topic><topic>Pharyngitis - therapy</topic><topic>Pneumonia</topic><topic>Prevalence</topic><topic>Tomography</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>House, Samantha A</creatorcontrib><creatorcontrib>Hall, Matthew</creatorcontrib><creatorcontrib>Ralston, Shawn L</creatorcontrib><creatorcontrib>Marin, Jennifer R</creatorcontrib><creatorcontrib>Coon, Eric R</creatorcontrib><creatorcontrib>Schroeder, Alan R</creatorcontrib><creatorcontrib>De Souza, Heidi Gruhler</creatorcontrib><creatorcontrib>Davidson, Amber</creatorcontrib><creatorcontrib>Duda, Patti</creatorcontrib><creatorcontrib>Ho, Timmy</creatorcontrib><creatorcontrib>Genies, Marquita C</creatorcontrib><creatorcontrib>Mestre, Marcos</creatorcontrib><creatorcontrib>Reyes, Mario A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>House, Samantha A</au><au>Hall, Matthew</au><au>Ralston, Shawn L</au><au>Marin, Jennifer R</au><au>Coon, Eric R</au><au>Schroeder, Alan R</au><au>De Souza, Heidi Gruhler</au><au>Davidson, Amber</au><au>Duda, Patti</au><au>Ho, Timmy</au><au>Genies, Marquita C</au><au>Mestre, Marcos</au><au>Reyes, Mario A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development and Use of a Calculator to Measure Pediatric Low-Value Care Delivered in US Children's Hospitals</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>4</volume><issue>12</issue><spage>e2135184</spage><pages>e2135184-</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>The scope of low-value care in children's hospitals is poorly understood.
To develop and apply a calculator of hospital-based pediatric low-value care to estimate prevalence and cost of low-value services.
This cross-sectional study developed and applied a calculator of hospital-based pediatric low-value care to estimate the prevalence and cost of low-value services among 1 011 950 encounters reported in 49 US children's hospitals contributing to the Pediatric Health Information System (PHIS) database. To develop the calculator, a multidisciplinary stakeholder group searched existing pediatric low-value care measures and used an iterative process to identify and operationalize relevant hospital-based measures in the PHIS database. Children with an eligible encounter in 2019 were included in the calculator-applied analysis. Two cohorts were analyzed: an emergency department cohort (with encounters resulting in emergency department discharge) and a hospitalized cohort.
Eligible condition-specific hospital encounters.
The proportion and volume of encounters in which low-value services were delivered and their associated standardized costs. Measures were ranked by those outcomes.
There were 1 011 950 encounters eligible for 1 or more of 30 calculator-included measures in 2019; encounters were incurred by 816 098 unique patients with a median age of 3 years (IQR, 1-8 years). In the emergency department cohort, low-value services delivered in the greatest percentage of encounters were Group A streptococcal testing among children younger than 3 years with pharyngitis (3679 of 9785 [37.6%]), computed tomography scan for minor head injury (7541 of 42 602 [17.7%]), and bronchodilators for treatment of bronchiolitis (8899 of 55 616 [16.0%]). In the hospitalized cohort, low-value care was most prevalent for broad-spectrum antibiotics in the treatment of community-acquired pneumonia (3406 of 5658 [60.2%]), acid suppression therapy for infants with esophageal reflux (3814 of 7507 of [50.8%]), and blood cultures for uncomplicated community-acquired pneumonia (2277 of 5823 [39.1%]). Measured low-value services generated nearly $17 million in total standardized cost. The costliest services in the emergency department cohort were computed tomography scan for abdominal pain (approximately $1.8 million) and minor head injury (approximately $1.5 million) and chest radiography for asthma (approximately $1.1 million). The costliest services in the hospitalized cohort were receipt of 2 or more concurrent antipsychotics (approximately $2.4 million), and chest radiography for bronchiolitis ($801 680) and asthma ($625 866).
This cross-sectional analysis found that low-value care for some pediatric services was prevalent and costly. Measuring receipt of low-value services across conditions informs prioritization of deimplementation efforts. Continued use of this calculator may establish trends in low-value care delivery.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34967884</pmid><doi>10.1001/jamanetworkopen.2021.35184</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Asthma Bronchiolitis - epidemiology Bronchiolitis - therapy Bronchodilators Child Child, Hospitalized Child, Preschool Craniocerebral Trauma - epidemiology Craniocerebral Trauma - therapy Cross-Sectional Studies Databases, Factual Head injuries Health Care Costs Hospitalization Hospitals, Pediatric - statistics & numerical data Humans Infant Low-Value Care Male Online Only Original Investigation Pediatrics Pharyngitis - epidemiology Pharyngitis - therapy Pneumonia Prevalence Tomography United States - epidemiology |
| title | Development and Use of a Calculator to Measure Pediatric Low-Value Care Delivered in US Children's Hospitals |
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