Improving healthcare value: The need to explicitly address equity in high‐value care

Liang, Danni; House, Samantha A.; Moriates, Christopher

doi:10.1002/jhm.13280

Cited by 1 publication

(1 citation statement)

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“…Similar to an achievable benchmark of care (ABC), 20 continue to gather data where we can on the equity and access implications of value improvement work. 39 A positive deviance approach has been posited as an effective method to improve the value of healthcare via studying the specific systems that consistently demonstrate the best performance. 40,41 In the case of routine laboratory testing, the results of this study highlight the feasibility and benefits of measuring data over time to identify these positive deviants.…”

Section: Discussionmentioning

confidence: 99%

Changing patterns of routine laboratory testing over time at children's hospitals

Tchou,

Hall,

Markham

et al. 2024

Journal of Hospital Medicine

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BackgroundResearch into low‐value routine testing at children's hospitals has not consistently evaluated changing patterns of testing over time.ObjectivesTo identify changes in routine laboratory testing rates at children's hospitals over ten years and the association with patient outcomes.Design, Settings, and ParticipantsWe performed a multi‐center, retrospective cohort study of children aged 0–18 hospitalized with common, lower‐severity diagnoses at 28 children's hospitals in the Pediatric Health Information Systems database.Main Outcomes and MeasuresWe calculated average annual testing rates for complete blood counts, electrolytes, and inflammatory markers between 2010 and 2019 for each hospital. A > 2% average testing rate change per year was defined as clinically meaningful and used to separate hospitals into groups: increasing, decreasing, and unchanged testing rates. Groups were compared for differences in length of stay, cost, and 30‐day readmission or ED revisit, adjusted for demographics and case mix index.ResultsOur study included 576,572 encounters for common, low‐severity diagnoses. Individual hospital testing rates in each year of the study varied from 0.3 to 1.4 tests per patient day. The average yearly change in hospital‐specific testing rates ranged from ‐6% to +7%. Four hospitals remained in the lowest quartile of testing and two in the highest quartile throughout all ten years of the study. We grouped hospitals with increasing (8), decreasing (n = 5), and unchanged (n = 15) testing rates. No difference was found across subgroups in costs, length of stay, 30‐day ED revisit, or readmission rates. Comparing resource utilization trends over time provides important insights into achievable rates of testing reduction.

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