Departments of Pediatrics, Emergency Medicine, and Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Center for Mental Health and Addiction Policy Research, Department of Health Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Pediatr. 2021 Aug;235:253-263.e14. doi: 10.1016/j.jpeds.2021.02.003. Epub 2021 Feb 6.
To estimate rates and settings of low-value imaging among pediatric Medicaid beneficiaries and estimate the associated expenditures.
Retrospective longitudinal cohort study from 2014 to 2016 of children <18 years enrolled in Pennsylvania Medicaid. Outcomes were rates of low-value imaging for 5 conditions identified by diagnosis codes, healthcare settings of imaging performance, and cost based on paid amounts.
Of the 645 767 encounters for the 5 conditions, there were 37 525 (5.8%) low-value imaging services. Per 1000 encounters, there were 246.0 radiographs for bronchiolitis, 174.0 head computed tomography (CT) studies for minor head trauma, 155.0 and 33.3 neuroimaging studies for headache and simple febrile seizure, respectively, and 19.5 abdominal CT scans (without prior ultrasound examination) for abdominal pain. Rates of low-value imaging were highest in non-Hispanic White children and those in rural areas. In adjusted analysis, non-Hispanic White children were more likely to receive a CT scan for abdominal pain, and Black children were more likely to have imaging for bronchiolitis and minor head trauma. For individual conditions, up to 87.9% of low-value imaging (CT scan for minor head trauma) was in the emergency department (ED), with most imaging across all conditions occurring in nonpediatric EDs, up to 42.2% was in the outpatient setting (neuroimaging for headache), and up to 20.7% was during inpatient encounters (neuroimaging for febrile seizure). Outpatient and ED low-value imaging resulted in more than $7 million in Medicaid expenditures.
Among the studied conditions, more than 1 in 20 encounters included low-value imaging, mostly in nonpediatric EDs and for bronchiolitis, head trauma, and headache. Interventions are needed to decrease the future performance of these low-value services.
评估小儿医疗补助受益人群中低价值影像的比例和发生场所，并估计相关支出。
本研究为 2014 年至 2016 年宾夕法尼亚州医疗补助计划中年龄<18 岁儿童的回顾性纵向队列研究。结果包括 5 种诊断编码相关疾病的低价值影像检查的比例、影像检查的实施场所，以及根据支付金额计算的成本。
在这 5 种疾病的 645767 次就诊中，有 37525 次（5.8%）为低价值影像服务。每千次就诊中，有 246.0 次 X 光检查用于细支气管炎，174.0 次头部 CT 检查用于轻微头部创伤，155.0 次和 33.3 次神经影像学检查分别用于头痛和单纯热性惊厥，19.5 次腹部 CT 扫描（无超声检查）用于腹痛。非西班牙裔白人和农村地区儿童的低价值影像比例最高。在调整分析中，非西班牙裔白人儿童更有可能接受腹部 CT 扫描，而黑人儿童更有可能接受 X 光检查用于细支气管炎和轻微头部创伤。对于个别疾病，多达 87.9%的低价值影像（轻微头部创伤的 CT 扫描）来自急诊部（ED），在所有疾病中，大多数影像来自非儿科 ED，高达 42.2%来自门诊（头痛的神经影像学），高达 20.7%来自住院患者（热性惊厥的神经影像学）。门诊和 ED 的低价值影像导致超过 700 万美元的医疗补助支出。
在所研究的疾病中，超过 1/20 的就诊包含低价值影像，主要来自非儿科 ED，用于细支气管炎、头部创伤和头痛。需要采取干预措施减少未来这些低价值服务的应用。
