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

• DOI: 10.1542/peds.2023-065524
• Publication Date: 2024-09-09T08:06:15Z
• Authors: 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; Jillian M. Cotter; Clemens Noelke; Rustin Morse; Samantha A. House
• Keywords: Odds

BACKGROUND AND OBJECTIVE Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed Childhood Opportunity Index (COI) 2.0 LVC in children’s hospitals. METHODS applied Pediatric Health Information System Calculator to emergency inpatient encounters from July 2021 through June 2022. Proportions with highest (greatest opportunity) lowest COI quintiles were compared. Generalized estimating equation logistic regression models used analyze trends across quintiles. RESULTS 842 463 eligible for 20 measures. Across all measures, odds increased increasing (adjusted ratio [OR] 1.06, 95% confidence interval [CI] 1.03–1.08). For 12 was proportionally more common versus quintile, whereas reverse true 4. Regression modeling revealed as 10 measures; gastric acid suppression infants had strongest association (OR 1.22, CI 1.17–1.27). Three measures decreasing quintiles; Group A streptococcal testing among children <3 years OR (0.85, 0.73–0.99). The absolute volume delivered greatest low most CONCLUSIONS Likelihood 3 trends. High volumes support a need broad de-implementation efforts; greater impact on lower opportunity warrant prioritized efforts.