Use of Low-Value Pediatric Services Among the Commercially Insured

Chua, Kao-Ping; Schwartz, Allen D.; Volerman, Anna; Conti, Rena M.; Huang, Elbert S.

doi:10.1542/peds.2016-1809

Cited by 53 publications

(68 citation statements)

References 62 publications

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“…However, this study did not perform a trend analysis. 17 Our results are comparable with these studies, reporting an initial increase in awareness and beliefs, followed by progressive changes in clinical practice among pediatric hospital-based clinicians in delivering evidence-based, high-value care after the CWC.…”

Section: <001supporting

confidence: 88%

Impact of the Choosing Wisely^® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Reyes

Etinger

Hall

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: The Choosing Wisely® Campaign (CWC) was launched in 2012. Five recommendations to reduce the use of “low-value” services in hospitalized children were published in 2013. OBJECTIVES: The aim of this study was to estimate the frequency and trends of utilization of these services in tertiary children’s hospitals five years before and after the publication of the recommendations. METHODS: We conducted a retrospective, longitudinal analysis of hospitalizations to 36 children’s hospitals from 2008 to 2017. The “low-value” services included (1) chest radiograph (CXR) for asthma, (2) CXR for bronchiolitis, (3) relievers for bronchiolitis, (4) systemic steroids for lower respiratory tract infection (LRTI), and (5) acid suppressor therapy for uncomplicated gastroesophageal reflux (GER). We estimated the annual percentages of the use of these services after risk adjustment, followed by an interrupted time series (ITS) analysis to compare trends before and after the publication of the recommendations. RESULTS: The absolute decreases in utilization were 36.6% in relievers and 31.5% in CXR for bronchiolitis, 24.1% in acid suppressors for GER, 20.8% in CXR for asthma, and 2.9% in steroids for LRTI. Trend analysis showed that one “low-value” service declined significantly immediately (use of CXR for asthma), and another decreased significantly over time (relievers for bronchiolitis) after the CWC. CONCLUSIONS: There was some decrease in the utilization of “low-value” services from 2008 to 2017. Limited changes in trends occurred after the publication of the recommendations. These findings suggest a limited impact of the CWC on clinical practice in these areas. Additional interventions are required for a more effective dissemination of the CWC recommendations for hospitalized children.

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Section: <001supporting

confidence: 88%

Impact of the Choosing Wisely^® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Reyes

Etinger

Hall

et al. 2019

Journal of Hospital Medicine

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“…Another important consideration in improving care would be to identify unnecessary care. 57,58 Our study has several limitations. First, this study is limited to analysis of data collected from 2007 to 2012, and it is possible that trends in AE prevalence have changed since then.…”

Section: Discussionmentioning

confidence: 94%

Adverse Events in Hospitalized Pediatric Patients

et al. 2018

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“…Despite efforts of campaigns and the dissemination of evidence-based guidelines to reduce the wasteful and unsustainable use of medical resources, pediatric patients continue to receive low-value care. 3 Here, we propose that 2 of the main vehicles for quality measurement do not currently align well with the intent of medical stewardship: quality measures and patient satisfaction scores.…”

mentioning

confidence: 99%

A (Not So) Perfectly Designed System: The Paradox of Medical Stewardship and Quality Measurement

Marin

Quiñonez

2019

Hospital Pediatrics

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Every system is perfectly designed to get the results it gets." 1 Health care quality measurement has become important for evaluating hospitals, practices, and individual clinicians. Unfortunately, our current quality measurement system is designed to reward those who do more even when doing more may not benefit, and may even harm, patients. Today, medical care is scrutinized through the lens of quality improvement and measurement, with patient experience being a key component of health care assessment. With medical overuse being described as a serious and extensive quality problem in US health care, 2 the current system will need to be redesigned for clinicians to effectively minimize unnecessary testing and treatments and, in short, champion medical stewardship. Despite efforts of campaigns and the dissemination of evidence-based guidelines to reduce the wasteful and unsustainable use of medical resources, pediatric patients continue to receive low-value care. 3 Here, we propose that 2 of the main vehicles for quality measurement do not currently align well with the intent of medical stewardship: quality measures and patient satisfaction scores. THE LACK OF OVERUSE QUALITY MEASURESPresent-day measures tend to favor assessments of underuse rather than overuse. As an example, .75% of the currently used quality process measures in pediatrics are used to target the underuse of health care services, such as documenting hydration status in gastroenteritis, obtaining a blood culture in patients with community-acquired pneumonia, and performing hearing testing for patients with otitis media with effusion. 4 The implementation of overuse measures, such as the administration of albuterol and/or steroids in bronchiolitis and appropriate testing for children with pharyngitis, is more challenging than that of underuse measures. Improving the adoption of a recommended test or intervention may be easier to conceptualize, accept, and measure. Deimplementation, or forgoing a test or intervention that evidence suggests should not happen, is more difficult to achieve. 5 When a patient receives a low-value test, even 1 that ultimately results in downstream harm, we do not typically view it as low-value care. In addition, many tests and interventions seen as the standard of care and subsequently proven to be of low value may be particularly challenging to deimplement. 6 For example, despite a randomized controlled trial from 2007 7 revealing no benefit of steroids for moderate-to-severe bronchiolitis, many young children continue to receive this therapy. 8

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Use of Low-Value Pediatric Services Among the Commercially Insured

Abstract: BACKGROUND: Claims-based measures of "low-value" pediatric services could facilitate the implementation of interventions to reduce the provision of potentially harmful services to children. However, few such measures have been developed.

Cited by 53 publications

References 62 publications

Impact of the Choosing Wisely^® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Impact of the Choosing Wisely^® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Adverse Events in Hospitalized Pediatric Patients

A (Not So) Perfectly Designed System: The Paradox of Medical Stewardship and Quality Measurement

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Use of Low-Value Pediatric Services Among the Commercially Insured

Abstract: BACKGROUND: Claims-based measures of "low-value" pediatric services could facilitate the implementation of interventions to reduce the provision of potentially harmful services to children. However, few such measures have been developed.

Cited by 53 publications

References 62 publications

Impact of the Choosing Wisely® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Impact of the Choosing Wisely® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Adverse Events in Hospitalized Pediatric Patients

A (Not So) Perfectly Designed System: The Paradox of Medical Stewardship and Quality Measurement

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Product

Resources

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Impact of the Choosing Wisely^® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017

Impact of the Choosing Wisely^® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017