Adherence to “Choosing Wisely” Recommendations in Pediatric Emergency Medicine - 18/03/25
Abstract |
Study objective |
In 2022, Choosing Wisely released recommendations to decrease the frequency of low-value testing in pediatric emergency medicine. The extent to which low-value testing occurs in US emergency departments (EDs) may vary by ED experience. We compared the frequency of low-value testing with ED volume.
Methods |
We conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project in all EDs in 8 states from January 1, 2014 to December 31, 2020. We included children aged below 18 years with one of the addressed diagnoses: respiratory tract illness, mental or behavioral health condition, seizure, constipation, or respiratory viral illness. ED volume was defined using National Pediatric Readiness Program categories of pediatric visits per year: less than 1,800 (low); 1,800 to 4,999 (low-medium); 5,000 to 9,999 (medium); or ≥10,000 (high) with an outcome of low-value testing, determined using procedure codes. We evaluated the adjusted association of volume with low-value testing using logistic regression with clustering by site.
Results |
We analyzed 5.6 million visits. Low-value tests were obtained in 19.3% of encounters. Low-value tests were obtained in 12.2% of visits to low-volume EDs, 20.5% for low-medium-volume EDs, 23.1% for medium-volume EDs, and 18.7% for high-volume EDs. Low-volume sites had the lowest rates of testing for mental or behavioral health conditions, constipation, and respiratory viral illness. High-volume sites had the lowest rates of testing for respiratory tract illness and seizure.
Conclusions |
Low-value testing occurred in one fifth of ED visits for children with a study condition. The relationship of ED volume to low-value testing was inconsistent across conditions.
Le texte complet de cet article est disponible en PDF.Keywords : Low-value care, Low-value testing, Pediatric emergency medicine, Choosing Wisely
Plan
| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Lise E. Nigrovic, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: TFC, JH, and KM conceived the study idea. TFC and KM designed the study. TFC and KM managed the data and carried out the analysis. All authors provided advice on study design and analysis. TFC drafted the manuscript and all authors contributed substantially to its revision. All authors take responsibility for the paper as a whole. TFC takes final responsibility for the paper. |
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| Data sharing statement: We cannot share the primary source data because of data use agreements prohibiting this; however, the HCUP databases are available for purchase. We will share analytic code upon reasonable request. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Michelson was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development award R01HD112321. The other authors report no conflict of interest. |
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