Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
Departments of Pediatrics.
Pediatrics. 2021 Oct;148(4). doi: 10.1542/peds.2021-051345. Epub 2021 Sep 23.
The American Academy of Pediatrics recommends against the routine use of β-agonists, corticosteroids, antibiotics, chest radiographs, and viral testing in bronchiolitis, but use of these modalities continues. Our objective for this study was to determine the patient, provider, and health care system characteristics that are associated with receipt of low-value services.
Using the Virginia All-Payers Claims Database, we conducted a retrospective cross-sectional study of children aged 0 to 23 months with bronchiolitis (code J21, ) in 2018. We recorded medications within 3 days and chest radiography or viral testing within 1 day of diagnosis. Using Poisson regression, we identified characteristics associated with each type of overuse.
Fifty-six percent of children with bronchiolitis received ≥1 form of overuse, including 9% corticosteroids, 17% antibiotics, 20% β-agonists, 26% respiratory syncytial virus testing, and 18% chest radiographs. Commercially insured children were more likely than publicly insured children to receive a low-value service (adjusted prevalence ratio [aPR] 1.21; 95% confidence interval [CI]: 1.15-1.30; < .0001). Children in emergency settings were more likely to receive a low-value service (aPR 1.24; 95% CI: 1.15-1.33; < .0001) compared with children in inpatient settings. Children seen in rural locations were more likely than children seen in cities to receive a low-value service (aPR 1.19; 95% CI: 1.11-1.29; < .0001).
Overuse in bronchiolitis remains common and occurs frequently in emergency and outpatient settings and rural locations. Quality improvement initiatives aimed at reducing overuse should include these clinical environments.
美国儿科学会建议在毛细支气管炎中不常规使用β激动剂、皮质类固醇、抗生素、胸部 X 光片和病毒检测，但这些方法仍在使用。本研究的目的是确定与接受低价值服务相关的患者、提供者和医疗保健系统特征。
我们使用弗吉尼亚州所有支付者索赔数据库，对 2018 年患有毛细支气管炎（代码 J21， ）的 0 至 23 个月大的儿童进行了回顾性横断面研究。我们记录了诊断后 3 天内的药物治疗和 1 天内的胸部 X 光片或病毒检测情况。使用泊松回归，我们确定了与每种过度使用相关的特征。
56%的毛细支气管炎患儿接受了≥1 种过度治疗，包括 9%的皮质类固醇、17%的抗生素、20%的β激动剂、26%的呼吸道合胞病毒检测和 18%的胸部 X 光片。商业保险儿童比公共保险儿童更有可能接受低价值服务（调整后的患病率比 [aPR] 1.21；95%置信区间 [CI]：1.15-1.30；<0.0001）。与住院患儿相比，急诊患儿更有可能接受低价值服务（aPR 1.24；95%CI：1.15-1.33；<0.0001）。与城市相比，农村地区的儿童更有可能接受低价值服务（aPR 1.19；95%CI：1.11-1.29；<0.0001）。
毛细支气管炎的过度治疗仍然很常见，并且经常发生在急诊和门诊环境以及农村地区。旨在减少过度治疗的质量改进举措应包括这些临床环境。
