Background Low-value care (LVC), or care in which potential risk outweighs perceived benefits, continues to impact pediatric populations. While pediatric healthcare delivery is known to vary across racial and ethnic groups, little is known about the relationship between race and ethnicity and LVC. We sought to evaluate this relationship among hospitalized children.Methods This cross-sectional study applied the Pediatric Health Information System LVC Calculator to encounters from July 1, 2022 to June 30, 2024. We used generalized estimating equation models to analyze differences in LVC across seven groups (Non-Hispanic White, Non-Hispanic Black, Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Other or Multiracial). For measures with across-group differences, we performed pairwise comparisons to assess differential odds of LVC receipt with the Non-Hispanic White group as a referent. We then performed a subanalysis applying these methods to only the largest groups.Results Of 14 eligible measures, LVC varied across racial and ethnic groups for seven. Patterns varied by measure, with no group demonstrating consistently high or low LVC. Measures with the greatest variation across groups included head computed tomography for first seizure, concurrent use of antipsychotics, and broad-spectrum antibiotics for uncomplicated community-acquired pneumonia. Our subanalysis demonstrated similar findings, with across-group differences noted for eight measures.Conclusions We identified differences in LVC receipt by race and ethnicity for some services among hospitalized patients, without consistency in patterns across measures. Further evaluation of drivers and outcomes associated with these patterns is needed; our findings may assist in prioritizing deimplementation efforts.
Pediatric residents are required to learn and demonstrate communication skills applicable to a range of cultural backgrounds, including patients and families who use a language other than English. Our study utilized an observational tool, the adapted Faculty Observer Rating Scale (aFORS), to characterize communication practices during interpreter-mediated family-centered rounds and compare behaviors by patient language and interpreter modality. Following 31 observations, we identified four behaviors performed <75% of the time: (1) providing clinical context to the interpreter, (2) allowing patient/caregiver to speak first, (3) teach-back, and (4) developing rapport. No differences were identified by patient language. During encounters with in-person interpreters, residents always used plain language (p-value 0.0149) and had higher-ranked adapted Faculty Observer Rating Scale (aFORS) summary scores (p-value 0.01). Curricula to train residents should focus on skills to strengthen interpreter partnership, build rapport with families, and mitigate challenges to working with remote interpreters.
Background Minimizing unnecessary sedation/anesthesia for pediatric brain MRI has been identified as an area for improvement. However, data on its use across a national sample of children's hospitals is lacking. Objective To understand patient demographics, clinical outcomes, hospital variation, and trends over time associated with sedation/anesthesia use for pediatric brain MRIs. Methods This retrospective cohort study utilized Pediatric Health Information System (PHIS) data for children < 18 years old who received an inpatient brain MRI from 2014 to 2024 (N = 215,377). Outcomes included the need for a repeat brain MRI, length of stay (LOS, in days), cost, and mortality. The likelihood of receiving sedation/anesthesia was modeled using Generalized Estimating Equations (GEE), clustered on hospital and adjusted for clinical and demographic factors. Outcomes were also modeled using GEEs. Results Sedation/anesthesia was used for 36% of children with no significant change over time. There was significant hospital variation in sedation/anesthesia use, ranging from 4.8% to 54.9%. Age, mental health diagnoses, and MRI type (contrast, limited) were associated with the likelihood of receiving sedation/anesthesia. Compared to no sedation/anesthesia, sedation/anesthesia use was associated with a lower likelihood of repeat MRI (1.7% vs. 5.6%, aOR 0.29, 95% CI: 0.25-0.34) and higher cost ($12,819 vs. $10,122, aRR 1.27, 95% CI: 1.13-1.42). There were no meaningful differences in LOS or mortality. Conclusion There is currently wide variability in the use of sedation/anesthesia across children's hospitals, and its use was associated with lower repeat MRIs but higher costs. Identification of appropriate patients and MRI techniques may be strategies to reduce unnecessary sedation/anesthesia.
