Low-Value Emergency Care and Racial and Ethnic Differences Across US Children's Hospitals

Abstract

Objectives: To examine (1) differences in low-value care (LVC) for common emergency conditions by race and ethnicity in US children's hospitals and (2) the association between hospital characteristics, including LVC rate, and the magnitude of within-hospital LVC differences by race and ethnicity. We hypothesized smaller LVC differences in hospitals with lower overall LVC rates.

Methods: We performed a cross-sectional study of children younger than 18 years discharged from the emergency department with asthma, bronchiolitis, headache, or minor head injury in the Pediatric Health Information System (PHIS) from January 2021 to June 2023. Exposures were patient race and ethnicity (non-Hispanic Black, "Black"; non-Hispanic white, "white"; Hispanic) and deidentified PHIS hospital. Outcomes were LVC by race and ethnicity within and across hospitals. We used multivariable logistic regression, reporting adjusted odds ratios (aORs) and 95% CI, to estimate hospital-level and condition-specific LVC differences and linear regression to examine the association between LVC differences and LVC rates.

Results: Among 314 138 eligible encounters, overall LVC rates were as follows: asthma 18%, bronchiolitis 32%, headache 24%, and minor head injury 26%. White compared with Black and Hispanic patients had higher odds of LVC across multiple conditions in pooled and within-hospital analyses. The largest pooled differences were for white vs Black: asthma aOR (95% CI) = 1.51 (1.18-1.95) and headache 1.57 (1.43-1.72). Hospital LVC rate was not associated with magnitude of within-hospital LVC difference for any condition.

Conclusions: Lower hospital LVC rates were not associated with reduced LVC differences. Intentional focus on LVC differences is important when designing LVC reduction efforts.