While we strive to focus our efforts on providing the highest quality care to children and their families, sometimes we provide low-value care (LVC) despite our intent. LVC is the delivery of health services for which the benefits do not outweigh the risks and costs. Are we reducing the amount of low-value care we provide for our patients?
We are early releasing in Pediatrics a study by House et al. entitled, “Trends in Low-Value Care Among Children’s Hospitals,” that used something called the “low-value care calculator,” a tool used to measure the proportion and volume of emergency department (ED) and hospital encounters involving up to 29 non-evidence-based services (10.1542/peds.2023-062492). Such services can include imaging and lab studies, medications, and procedures. In this study, the calculator was applied to 5.2 million ED encounters and 1.3 million hospitalizations from 49 hospitals over 2016 to 2022. The authors found that of the 21 low-value measures applicable to the ED, the percent of LVC encounters increased for 11, decreased for 1, and was unchanged for 9. Going in the wrong direction were CT scans for minor head injury (17% to 23%, p<.001) and the use of bronchodilators for bronchiolitis (22% to 27%, p=.001). As for inpatient hospitalizations, 26 measures were studied and LVC increased for 6, decreased for 9, and were unchanged for 11. Overall inpatient and ED LVC was unchanged or decreased for most medications or procedures whereas laboratory and imaging measures remained unchanged or increased.
The authors call for targeted deimplementation of some LVC services. There is high value in linking to this article to reduce LVC in your practice.