Overuse of low-value services in bronchiolitis occurred in 56% of children, with higher rates among those commercially insured (aPR 1.21; 95% CI 1.15-1.30), in emergency settings, or rural locations.
Cross-Sectional
Yes
What patient, provider, and health care system characteristics are associated with the receipt of low-value services in children with bronchiolitis?
Overuse of non-recommended services in bronchiolitis remains common, particularly among commercially insured children and those seen in emergency or rural settings.
Effect estimate: aPR 1.21 (95% CI 1.15-1.30)
p-value: p=<0.0001
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends against the routine use of β-agonists, corticosteroids, antibiotics, chest radiographs, and viral testing in bronchiolitis, but use of these modalities continues. Our objective for this study was to determine the patient, provider, and health care system characteristics that are associated with receipt of low-value services. METHODS Using the Virginia All-Payers Claims Database, we conducted a retrospective cross-sectional study of children aged 0 to 23 months with bronchiolitis (code J21, International Classification of Diseases, 10th Revision) in 2018. We recorded medications within 3 days and chest radiography or viral testing within 1 day of diagnosis. Using Poisson regression, we identified characteristics associated with each type of overuse. RESULTS Fifty-six percent of children with bronchiolitis received ≥1 form of overuse, including 9% corticosteroids, 17% antibiotics, 20% β-agonists, 26% respiratory syncytial virus testing, and 18% chest radiographs. Commercially insured children were more likely than publicly insured children to receive a low-value service (adjusted prevalence ratio aPR 1.21; 95% confidence interval CI: 1.15–1.30; P .0001). Children in emergency settings were more likely to receive a low-value service (aPR 1.24; 95% CI: 1.15–1.33; P .0001) compared with children in inpatient settings. Children seen in rural locations were more likely than children seen in cities to receive a low-value service (aPR 1.19; 95% CI: 1.11–1.29; P .0001). CONCLUSIONS Overuse in bronchiolitis remains common and occurs frequently in emergency and outpatient settings and rural locations. Quality improvement initiatives aimed at reducing overuse should include these clinical environments.
Wolf et al. (Thu,) conducted a cross-sectional in Bronchiolitis. Commercial insurance, emergency settings, and rural locations vs. Public insurance, inpatient settings, and city locations was evaluated on Receipt of low-value services (overuse) (aPR 1.21, 95% CI 1.15-1.30, p=<0.0001). Overuse of low-value services in bronchiolitis occurred in 56% of children, with higher rates among those commercially insured (aPR 1.21; 95% CI 1.15-1.30), in emergency settings, or rural locations.