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Use of low-value pediatric services in the Military Health System

BACKGROUND: Low-value care (LVC) is understudied in pediatric populations and in the Military Health System (MHS). This cross-sectional study applies previously developed measures of pediatric LVC diagnostic tests, procedures, and treatments to children receiving care within the direct and purchased...

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Autores principales: Koehlmoos, Tracey Pérez, Madsen, Cathaleen, Banaag, Amanda, Li, Qiong, Schoenfeld, Andrew J., Weissman, Joel S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441552/
https://www.ncbi.nlm.nih.gov/pubmed/32819375
http://dx.doi.org/10.1186/s12913-020-05640-5
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author Koehlmoos, Tracey Pérez
Madsen, Cathaleen
Banaag, Amanda
Li, Qiong
Schoenfeld, Andrew J.
Weissman, Joel S.
author_facet Koehlmoos, Tracey Pérez
Madsen, Cathaleen
Banaag, Amanda
Li, Qiong
Schoenfeld, Andrew J.
Weissman, Joel S.
author_sort Koehlmoos, Tracey Pérez
collection PubMed
description BACKGROUND: Low-value care (LVC) is understudied in pediatric populations and in the Military Health System (MHS). This cross-sectional study applies previously developed measures of pediatric LVC diagnostic tests, procedures, and treatments to children receiving care within the direct and purchased care environments of the MHS. METHODS: We queried the MHS Data Repository (MDR) to identify children (n = 1,111,534) who received one or more of 20 previously described types of LVC in fiscal year 2015. We calculated the proportion of eligible children and all children who received the service at least once during fiscal year 2015. Among children eligible for each measure, we used logistic regressions to calculate the adjusted odds ratios (AOR) for receiving LVC at least once during fiscal year 2015 in direct versus purchased care. RESULTS: All 20 measures of pediatric LVC were found in the MDR. Of the 1,111,534 eligible children identified, 15.41% received at least one LVC service, and the two most common procedures were cough and cold medications in children under 6 years and acid blockers for infants with uncomplicated gastroesophageal reflux. Eighteen of the 20 measures of pediatric LVC were eligible for comparison across care environments: 6 were significantly more likely to be delivered in direct care and 10 were significantly more likely to be delivered in purchased care. The greatest differences between direct and purchased care were seen in respiratory syncytial virus testing in children with bronchiolitis (AOR = 21.01, 95% CI = 12.23–36.10) and blood tests in children with simple febrile seizure (AOR = 24.44, 95% CI = 5.49–108.82). A notably greater difference of inappropriate antibiotic prescribing was seen in purchased versus direct care. CONCLUSIONS: Significant differences existed between provision of LVC services in direct and purchased care, unlike previous studies showing little difference between publicly and privately insured children. In fiscal year 2015, 1 in 7 children received one of 20 types of LVC. These proportions are higher than prior estimates from privately and publicly insured children, suggesting the particular need to focus on decreasing wasteful care in the MHS. Collectively, these studies demonstrate the high prevalence of LVC in children and the necessity of reducing potentially harmful care in this vulnerable population.
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spelling pubmed-74415522020-08-24 Use of low-value pediatric services in the Military Health System Koehlmoos, Tracey Pérez Madsen, Cathaleen Banaag, Amanda Li, Qiong Schoenfeld, Andrew J. Weissman, Joel S. BMC Health Serv Res Research Article BACKGROUND: Low-value care (LVC) is understudied in pediatric populations and in the Military Health System (MHS). This cross-sectional study applies previously developed measures of pediatric LVC diagnostic tests, procedures, and treatments to children receiving care within the direct and purchased care environments of the MHS. METHODS: We queried the MHS Data Repository (MDR) to identify children (n = 1,111,534) who received one or more of 20 previously described types of LVC in fiscal year 2015. We calculated the proportion of eligible children and all children who received the service at least once during fiscal year 2015. Among children eligible for each measure, we used logistic regressions to calculate the adjusted odds ratios (AOR) for receiving LVC at least once during fiscal year 2015 in direct versus purchased care. RESULTS: All 20 measures of pediatric LVC were found in the MDR. Of the 1,111,534 eligible children identified, 15.41% received at least one LVC service, and the two most common procedures were cough and cold medications in children under 6 years and acid blockers for infants with uncomplicated gastroesophageal reflux. Eighteen of the 20 measures of pediatric LVC were eligible for comparison across care environments: 6 were significantly more likely to be delivered in direct care and 10 were significantly more likely to be delivered in purchased care. The greatest differences between direct and purchased care were seen in respiratory syncytial virus testing in children with bronchiolitis (AOR = 21.01, 95% CI = 12.23–36.10) and blood tests in children with simple febrile seizure (AOR = 24.44, 95% CI = 5.49–108.82). A notably greater difference of inappropriate antibiotic prescribing was seen in purchased versus direct care. CONCLUSIONS: Significant differences existed between provision of LVC services in direct and purchased care, unlike previous studies showing little difference between publicly and privately insured children. In fiscal year 2015, 1 in 7 children received one of 20 types of LVC. These proportions are higher than prior estimates from privately and publicly insured children, suggesting the particular need to focus on decreasing wasteful care in the MHS. Collectively, these studies demonstrate the high prevalence of LVC in children and the necessity of reducing potentially harmful care in this vulnerable population. BioMed Central 2020-08-20 /pmc/articles/PMC7441552/ /pubmed/32819375 http://dx.doi.org/10.1186/s12913-020-05640-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Koehlmoos, Tracey Pérez
Madsen, Cathaleen
Banaag, Amanda
Li, Qiong
Schoenfeld, Andrew J.
Weissman, Joel S.
Use of low-value pediatric services in the Military Health System
title Use of low-value pediatric services in the Military Health System
title_full Use of low-value pediatric services in the Military Health System
title_fullStr Use of low-value pediatric services in the Military Health System
title_full_unstemmed Use of low-value pediatric services in the Military Health System
title_short Use of low-value pediatric services in the Military Health System
title_sort use of low-value pediatric services in the military health system
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441552/
https://www.ncbi.nlm.nih.gov/pubmed/32819375
http://dx.doi.org/10.1186/s12913-020-05640-5
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