Disparities in Low-Value Pediatric Care in Hospital Settings Based on Race and Ethnicity

Background

Low-value care (LVC) refers to healthcare services where the potential benefits do not outweigh the harms or costs, particularly affecting pediatric populations. Understanding the influence of sociodemographic characteristics on LVC delivery is crucial for addressing healthcare inequities. Previous studies have shown variations in LVC delivery among adults based on race and ethnicity, but similar research in pediatric populations remains limited.

Data Highlights

The analysis utilized the Pediatric Health Information System (PHIS) LVC Calculator, assessing 30 measures of low-value medications, imaging, and procedures among hospitalized children.

Key Findings

• Racial and ethnic variation in LVC delivery has been observed, with potential contributing factors including patient and provider biases.
• Higher rates of low-value imaging have been reported among non-Hispanic white children in emergency departments.
• Emerging literature indicates a phenomenon of 'double jeopardy' where certain racial and ethnic groups experience both overuse of low-value services and underuse of high-value services.
• Prior research has documented differences in LVC delivery according to payer and childhood opportunity, but racial and ethnic disparities have not been thoroughly investigated.
• The PHIS LVC Calculator provides a framework for evaluating LVC delivery in pediatric populations.

Clinical Implications

Healthcare providers should be aware of the potential for racial and ethnic disparities in the delivery of low-value care. Addressing these disparities may require targeted interventions and policy changes to ensure equitable healthcare access and outcomes for all pediatric patients.

Conclusion

The evaluation of LVC delivery among hospitalized children reveals significant racial and ethnic disparities that warrant further investigation and action to mitigate healthcare inequities.

Related Resources & Content

1. Zhao J, et al., Cancer Epidemiology, Biomarkers & Prevention, 2021 -- Improved Health Insurance Coverage, Access to Care May Lessen Racial/Ethnic Disparities in Childhood Cancer Survival
2. Doctors Report, Anesthesia Inequities Affect Black Patients, 2021 -- Anesthesia Inequities Affect Black Patients, Doctors Report
3. Redressing Representation, 2024 -- Redressing Representation
4. American Academy of Pediatrics, Pediatrics, 2024 -- Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement
5. American Academy of Pediatrics, Pediatrics, 2023 -- Trends in Low-Value Care Among Children’s Hospitals
6. PMC, 2023 -- Low-Value Emergency Care and Racial and Ethnic Differences Across US Children’s Hospitals
7. Journal of General Internal Medicine — Connecting or Manipulating? Exploring the Dilemma in Patient Care
8. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement | Pediatrics | American Academy of Pediatrics
9. Trends in Low-Value Care Among Children’s Hospitals | Pediatrics | American Academy of Pediatrics
10. Low-Value Emergency Care and Racial and Ethnic Differences Across US Children’s Hospitals - PMC