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. 2024 Oct 1;154(4):e2023065524.
doi: 10.1542/peds.2023-065524.

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

Irma T Ugalde  1 , Alan R Schroeder  2 , Jennifer R Marin  3 , Matt Hall  4 , Elisha McCoy  5 , Monika K Goyal  6 , Matthew J Molloy  7 , John R Stephens  8 , Michael J Steiner  8 , Michael J Tchou  9 , Jessica L Markham  10 , Jillian M Cotter  9 , Clemens Noelke  11 , Rustin Morse  12 , Samantha A House  13
Affiliations

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

Irma T Ugalde et al. Pediatrics. .

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 <3 years revealed the lowest OR (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.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Odds of receipt of LVC per individual measure across COI quintiles. Circles represent point estimates, whereas horizontal lines represent 95% CI.
See this image and copyright information in PMC

Comment in

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