Low-value care encounters more common in disadvantaged neighborhoods

Key takeaways:

• The odds of low-value care incidents grew 6% with each COI quintile increase.
• Ten LVC measures were positively associated with COI, and 3 had a negative association.

Low-value care encounters are more likely to occur in neighborhoods with a high Childhood Opportunity Index, but the overall volume of low-value care encounters is highest among areas with a low index, according to a study.

“In this study, we applied the Pediatric Health Information System Low-Value Care Calculator (LVC Calculator) to examine the association between Childhood Opportunity Index (COI) 2.0 and LVC delivery in children’s hospitals,” Irma T. Ugalde, MD, associate professor and director of pediatric emergency medicine research at University of Texas McGovern Medical School, and colleagues wrote. “We hypothesized that children with greater neighborhood opportunity would be more likely than those with lower opportunity to receive low-value services.”

The COI 2.0 measures the conditions of neighborhoods, where lower COI is associated with poorer health outcomes in children. The LVC calculator uses 30 criteria, including medications, laboratory and imaging tests and procedures that are deemed unnecessary.

The researchers analyzed 842,463 emergency and inpatient encounters that occurred from July 1, 2021, through June 30, 2022, in children’s hospitals with at least one LVC measure.

The largest proportion of encounters (29%) were in the lowest COI quintile neighborhoods. The researchers found the odds of LVC incidents grew 6% with each COI quintile increase (OR = 1.06; 95% CI, 1.03-1.08).

Twelve LVC measures occurred in a larger proportion of highest COI quintile encounters, 10 of which were more likely to occur as COI increased. The procedures with the strongest positive association with COI were acid suppression therapy in infants and ordering an MRI for primary atraumatic headaches.

Four measures were more common among the lowest COI neighborhoods, of which three had a negative association with COI. The measures that had the strongest negative association with COI were concurrent antipsychotic administration and group A streptococcal testing among young children.

“Despite higher proportions of LVC in the very high COI quintile for a majority of measures, the absolute volume of LVC was highest in the very low COI quintile for 12 measures,” the researchers wrote. “The higher representation of children from lower COI quintiles in our cohort may explain this finding.”