Childhood Opportunity Index and Low-Value Care in Children's Hospitals.

Creator(s)

Irma T. Ugalde
Alan R. Schroeder
Jennifer R. Marin
Matt Hall
Elisha McCoy
Monika K. Goyal
Matthew J. Molloy
John R. Stephens
Michael J. Steiner
Michael J. Tchou
Jessica L. Markham, Children's Mercy HospitalFollow
Jillian M. Cotter
Clemens Noelke
Rustin Morse
Samantha A. House

Document Type

Article

Publication Date

10-1-2024

Identifier

DOI: 10.1542/peds.2023-065524; PMCID: PMC11442119

Abstract

BACKGROUND AND OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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(0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures.

CONCLUSIONS: 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.

Journal Title

Pediatrics

Volume

154

Issue

4

MeSH Keywords

Humans; Hospitals, Pediatric; Child; Child, Preschool; Infant; Female; Male; Adolescent; Infant, Newborn; United States; Social Determinants of Health

Keywords

Pediatric Hospitals; United States; Social Determinants of Health

Comments

Grants and funding

• K12 TR004412/TR/NCATS NIH HHS/United States

Recommended Citation

Ugalde IT, Schroeder AR, Marin JR, et al. Childhood Opportunity Index and Low-Value Care in Children's Hospitals. Pediatrics. 2024;154(4):e2023065524. doi:10.1542/peds.2023-065524