Appropriately Framing Child Health Care Spending

Chua, Kao-Ping; Conti, Rena M.; Freed, Gary L.

doi:10.1001/jama.2018.0014

Cited by 19 publications

(18 citation statements)

References 4 publications

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“…[24][25][26] In the field of pediatrics, health care spending has increased by >50% in the United States over the past 2 decades, 27,28 and up to 30% of this spending is on low-value care practices that prolong hospitalizations and increase use without improving patient outcomes. 29,30 In recognition of the ongoing challenges posed by low-value care and building on the original SHM CW effort, the SHM sought to delineate new priorities for improving health care value for hospitalized children. In April 2018, the SHM sponsored the development of a second CW list for PHM with the support of the Academic Pediatric Association (APA) and the American Academy of Pediatrics (AAP).…”

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confidence: 99%

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

Tchou

Schondelmeyer

Álvarez

et al. 2021

Hospital Pediatrics

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OBJECTIVES The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children. METHODS A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research. The study team surveyed national pediatric hospitalist LISTSERVs for suggestions, condensed similar responses, and performed a literature search of articles published in the previous 10 years. Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations. RESULTS Two hundred seven respondents suggested 397 preliminary recommendations, yielding 74 unique recommendations that underwent evidence review and rating. The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis. CONCLUSIONS We propose that pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.

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confidence: 99%

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

Tchou

Schondelmeyer

Álvarez

et al. 2021

Hospital Pediatrics

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“…1 Reducing the provision of low-value services could decrease health care spending while maintaining or even improving outcomes. 2,3 Nationally, major efforts are underway to achieve this goal, including campaigns to increase public and clinician awareness of low-value services (eg, Choosing Wisely) as well as payment and delivery reforms that aim to incentivize the delivery of efficient care (eg, accountable care organizations). [4][5][6] In children, quality improvement efforts have been focused on low-value services across a broad range of settings, including inappropriate antibiotic prescribing in primary care offices, unnecessary imaging for minor head trauma in emergency departments, and overuse of bronchodilators during hospitalization for bronchoilitis.…”

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confidence: 99%

Differences in the Receipt of Low-Value Services Between Publicly and Privately Insured Children

et al. 2020

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BACKGROUND: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. METHODS: We analyzed 2013–2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. RESULTS: Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). CONCLUSIONS: In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.

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“…Health care spending in pediatrics is rising sharply, with profound and growing consequences for patients, families, and health systems. [1][2][3] A significant proportion of this spending can be categorized as overuse, 4 which is defined as the delivery of health care for which net benefits do not exceed net harms. 5 In particular, overuse of laboratory testing, especially repeat daily testing in which there is a low pretest probability of a clinically significant result, contributes substantially to waste.…”

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confidence: 99%

Patterns of Electrolyte Testing at Children’s Hospitals for Common Inpatient Diagnoses

et al. 2019

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BACKGROUND: Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospitallevel testing across common inpatient diagnoses could identify outliers and inform wastereduction efforts. METHODS: We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared riskadjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing. RESULTS: In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r 5 0.63; repeat r 5 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis. CONCLUSIONS: Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing. WHAT'S KNOWN ON THIS SUBJECT: Overuse of laboratory testing contributes to health care waste. A better understanding of the variation in electrolyte testing rates across hospitals may inform future research and improvement interventions that target overuse. WHAT THIS STUDY ADDS: Wide variation in testing rates were observed across hospitals, with strong associations between rates of testing across multiple diagnoses at individual hospitals. These results suggest the potential for overuse of electrolyte testing at least partially related to hospital-level factors.

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Appropriately Framing Child Health Care Spending

Cited by 19 publications

References 4 publications

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

Differences in the Receipt of Low-Value Services Between Publicly and Privately Insured Children

Patterns of Electrolyte Testing at Children’s Hospitals for Common Inpatient Diagnoses

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