Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas.
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Pediatrics. 2024 Oct 1;154(4). doi: 10.1542/peds.2023-065524.
Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals.
We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles.
842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures.
Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts.
很少有研究探讨健康的社会驱动因素与儿科低价值医疗（LVC）之间的关系。我们评估了儿童机会指数（COI）2.0 与儿童医院 LVC 之间的关系。
我们应用儿科健康信息系统 LVC 计算器对 2021 年 7 月至 2022 年 6 月的急诊和住院患者进行分析。比较 LVC 发生率最高（机会最多）和最低 COI 五分位数的比例。使用广义估计方程逻辑回归模型分析 COI 五分位数之间的 LVC 趋势。
共有 842463 次就诊符合 20 项 LVC 措施的要求。在所有措施中，随着 COI 五分位数的增加，LVC 的可能性增加（调整比值比 [OR] 1.06，95%置信区间 [CI] 1.03-1.08）。对于 12 项措施，LVC 在最高 COI 五分位数中比最低 COI 五分位数更为常见，而对于 4 项措施则相反。回归模型显示，随着 COI 的增加，所有五分位数的 LVC 都呈增加趋势；对于婴儿胃酸抑制的关联最强（OR 1.22，95%CI 1.17-1.27）。有 3 项措施显示随着 COI 五分位数的增加 LVC 呈下降趋势；3 岁以下儿童 A 组链球菌检测的 OR 最低（0.85，95%CI 0.73-0.99）。对于大多数措施，低 COI 五分位数的 LVC 实施量最大。
在 20 项措施中，有 10 项措施的 LVC 可能性随着 COI 五分位数的增加而增加，而 3 项措施则呈现相反的趋势。各个五分位数的 LVC 大量实施表明需要广泛的去实施努力；对机会较低的儿童影响更大的措施需要优先考虑。
