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. 2016 Dec;138(6):e20161809.
doi: 10.1542/peds.2016-1809.

Use of Low-Value Pediatric Services Among the Commercially Insured

Kao-Ping Chua  1   2 , Aaron L Schwartz  3 , Anna Volerman  4   5 , Rena M Conti  2   6 , Elbert S Huang  5
Affiliations

Use of Low-Value Pediatric Services Among the Commercially Insured

Kao-Ping Chua et al. Pediatrics. 2016 Dec.

Erratum in

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.

Methods: We developed claims-based measures of 20 services that typically do not improve child health according to evidence-based guidelines (eg, cough and cold medicines). Using these measures and claims from 4.4 million commercially insured US children in the 2014 Truven MarketScan Commercial Claims and Encounters database, we calculated the proportion of children who received at least 1 low-value pediatric service during the year, as well as total and out-of-pocket spending on these services. We report estimates based on "narrow" measures designed to only capture instances of service use that were low-value. To assess the sensitivity of results to measure specification, we also reported estimates based on "broad measures" designed to capture most instances of service use that were low-value.

Results: According to the narrow measures, 9.6% of children in our sample received at least 1 of the 20 low-value services during the year, resulting in $27.0 million in spending, of which $9.2 million was paid out-of-pocket (33.9%). According to the broad measures, 14.0% of children in our sample received at least 1 of the 20 low-value services during the year.

Conclusions: According to a novel set of claims-based measures, at least 1 in 10 children in our sample received low-value pediatric services during 2014. Estimates of low-value pediatric service use may vary substantially with measure specification.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Schwartz reports consulting on quality measurement for Nuna Inc; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Distribution of: A, low-value service counts, B, out-of-pocket spending on low-value services, and C, total spending on low-value services. Estimates are based on the narrow measures and represent the proportion of sample totals accounted for by low-value diagnostic tests, imaging tests, and prescription drugs.
See this image and copyright information in PMC

Comment in

  • Choosing Wrong.
    Quinonez RA, Coon ER. Quinonez RA, et al. Pediatrics. 2016 Dec;138(6):e20163228. doi: 10.1542/peds.2016-3228. Pediatrics. 2016. PMID: 27940750 No abstract available.

References

    1. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–1802 - PubMed
    1. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–296 - PubMed
    1. Baker DW, Qaseem A, Reynolds PP, Gardner LA, Schneider EC; American College of Physicians Performance Measurement Committee . Design and use of performance measures to decrease low-value services and achieve cost-conscious care. Ann Intern Med. 2013;158(1):55–59 - PubMed
    1. Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring low-value care in Medicare. JAMA Intern Med. 2014;174(7):1067–1076 - PMC - PubMed
    1. Colla CH, Morden NE, Sequist TD, Schpero WL, Rosenthal MB. Choosing wisely: prevalence and correlates of low-value health care services in the United States. J Gen Intern Med. 2015;30(2):221–228 - PMC - PubMed

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