Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, and New Hampshire Dartmouth Health Children's, Lebanon, New Hampshire.
UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Pediatrics. 2024 Jan 1;153(1). doi: 10.1542/peds.2023-062492.
Longitudinal pediatric low-value care (LVC) trends are not well established. We used the Pediatric Health Information System LVC Calculator, which measures utilization of 30 nonevidenced-based services, to report 7-year LVC trends.
This retrospective cohort study applied the LVC Calculator to emergency department (ED) and hospital encounters from January 1, 2016, to December 31, 2022. We used generalized estimating equation models accounting for hospital clustering to assess temporal changes in LVC.
There were 5 265 153 eligible ED encounters and 1 301 613 eligible hospitalizations. In 2022, of 21 LVC measures applicable to the ED cohort, the percentage of encounters with LVC had increased for 11 measures, decreased for 1, and remained unchanged for 9 as compared with 2016. Computed tomography for minor head injury had the largest increase (17%-23%; P < .001); bronchodilators for bronchiolitis decreased (22%-17%; P = .001). Of 26 hospitalization measures, LVC increased for 6 measures, decreased for 9, and was unchanged for 11. Inflammatory marker testing for pneumonia had the largest increase (23%-38%; P = .003); broad-spectrum antibiotic use for pneumonia had the largest decrease (60%-48%; P < .001). LVC remained unchanged or decreased for most medication and procedure measures, but remained unchanged or increased for most laboratory and imaging measures.
LVC improved for a minority of services between 2016 and 2022. Trends were more favorable for therapeutic (medications and procedures) than diagnostic measures (imaging and laboratory studies). These data may inform prioritization of deimplementation efforts.
纵向儿科低价值医疗（LVC）趋势尚不清楚。我们使用儿科健康信息系统 LVC 计算器，该计算器衡量 30 种无证据支持的服务的利用情况，报告了 7 年的 LVC 趋势。
本回顾性队列研究将 LVC 计算器应用于 2016 年 1 月 1 日至 2022 年 12 月 31 日期间的急诊部（ED）和住院就诊。我们使用广义估计方程模型来评估 LVC 的时间变化，这些模型考虑了医院聚类。
共有 526.5153 万例符合条件的 ED 就诊和 130.1613 万例符合条件的住院治疗。在 2022 年，对于适用于 ED 队列的 21 项 LVC 措施中的 21 项，与 2016 年相比，11 项 LVC 就诊的比例增加，1 项减少，9 项不变。对于轻微头部损伤的计算机断层扫描，增加幅度最大（17%-23%；P <.001）；支气管扩张剂用于细支气管炎减少（22%-17%；P =.001）。在 26 项住院治疗措施中，LVC 增加了 6 项，减少了 9 项，11 项保持不变。对于肺炎的炎症标志物检测，增加幅度最大（23%-38%；P =.003）；广谱抗生素用于肺炎的使用量下降幅度最大（60%-48%；P <.001）。大多数药物和程序措施的 LVC 保持不变或减少，但大多数实验室和影像学措施的 LVC 保持不变或增加。
2016 年至 2022 年期间，少数服务的 LVC 有所改善。治疗措施（药物和程序）的趋势好于诊断措施（影像学和实验室研究）。这些数据可能有助于优先考虑去实施工作。
